High School Research (Independent) - Registration
Student's First Name:
Student's Last Name:
Address
Street:
City:
State:
, Zip+4:
Email:
(
Your registration will be copied to the email address you provide. Changes/edits should be sent to:
kkernan@notes.cc.sunysb.edu
)
Phone (with area code):
Date of Birth (MM/DD/YYYY):
Emergency Contact Name:
Emergency Contact Phone (with area code):
Emergency Contact Relation:
High School:
High School Advisor/Teacher:
Name of Stony Brook Faculty Mentor:
How did you find your research placement?:
Select...
Personal Contact
Teacher/Science research course
Stony Brook Web site
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If other:
How long will you be working on campus at a Stony Brook lab?:
Last modified on
07/04/2009 01:38:14 AM
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