SURI Application Form

To ensure timely consideration of your application, we ask that you provide the following information. Items marked with an asterisk (*) are required. Please abbreviate where necessary.

Name
*First Name:
Middle Initial:
*Last Name:
Suffix (eg. Jr., III):
Citizenship: I am
a US citizen,
a resident alien (green card holder), or
a non-resident alien.
 
Present Address Information
*Email Address:
*Postal Address Line 1:
Line 2:
*City:
State/Province:
Zip or Postal Code:
Country:
*Phone:
 
Permanent Address Information
Postal Address Line 1:
Line 2:
City:
State/Province:
Zip or Postal Code:
Country:
Phone:
 
Education Information
*University:
*Major Area of Study: (e.g., EE, ME, Physics, Chemistry, etc.)
*Current Classification:
*Grade Point Average: / 4.00
*Expected Graduation Date: Month:   Year:
 
Please list related courses you are taking/have taken
 
 
What are you plans following graduation?
 
 
 

Before clicking on the submit button, please double check your entries as there is no opportunity for on-line corrections!
Once you have pressed Submit, you will be taken to a page with further instructions.