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?: How long will you be working on campus at a Stony Brook lab?:



Last modified on 08/29/2008 02:19:32 PM
Maintained by University Webmaster