Application | Latham Science Engagement Fellowship Program

Personal Background

First Name *

Middle Name *

Last Name *

Email *

Mailing Address *

City *

State *

Zip Code *

Daytime Phone *

Date of Birth *

Month

Day

Year

Year in School *

Anticipated Undergraduate Graduation Date *

Major / Intended Major *

Ethnicity *

Alaskan Native/American Indian

African American or Black

Asian

Hispanic or Latin(o/a)

Native Hawaiian or Other Pacific Islander

White

International (non-US-Citizen)

Unknown

I do not wish to provide this information

Check all that apply.

Essay

Essay *

Share with us your views regarding scientific engagement and innovation in meeting the needs of society in today’s world (500 words or less).

Project Idea *

Describe your vision for a possible outreach project you would like to implement (200 words or less).

Letter of Recommendation

The Latham Fellowship Program will receive a letter of recommendation in support of my application from the following research advisor or mentor *

The letter should be emailed to CLAS-Latham@uiowa.edu.

LFP Information

How did you find out about the LFP program? *

If other (please explain)

CV/Resume

Along with submission of this form, please submit your CV/Resume to clas-latham@uiowa.edu or brinda-shetty@uiowa.edu.

Course Times *

I agree

I do not agree

I am able to attend the Fall LATH:3000 and Spring LATH:3001 classes at the times currently listed (Thursdays from 8:30-10:10 am).

Release of Information *

I agree

I do not agree

My academic standing is a factor for admission to the Latham Fellowship Program; therefore, I give permission to LFP staff to obtain my transcripts.

Leave this field blank