Personal Information

Research Experience for Undergraduates

Personal Information Sheet
Printable Personal Information Sheet

Please complete the Personal Information Form by Wednesday, April 30th, 2008. Also, to help us in preparing roommates, please fill out the question and answer information. If you already know who you want to room with, both of you must indicate that on this form.

Personal Information

First and Last Name

Email Address

Date of Birth

Cell Phone

Travel Arrangements
Driving
Flying
If flying please e-mail or fax me your flight itinerary.
Kimberly.Wingo@usm.edu or Fax: 601-266-5635

Do you need a parking permit ?
Yes No

Gender
Male Female

If you would like to request sharing a room with another REU student, please list their name.

If not, please fill in the information below.

Hobbies:

Favorite Singer/Group/Genre of Music:

Are you an early to rise or late to bed person?

Please list someone for us to contact in case of an emergency.

1) First and Last Name

Phone Number

2) First and Last Name

Phone Number

Date Electronic Signature