2. SIUE ID# 3. Local Address 4. Permanent Address (if different from above) 5. Telephone Cell Residence 6. E-mail Address @siue.edu For stipend processing information only (your answers will in no way affect your application), please answer the following: 7. Do you have a social security number? (Do NOT provide SSN here.) Yes No 8. Are you a foreign national? Yes No 9. Academic Major 10. Hours Completed 11. GPA (4-point scale) 12. Project Title 13. Mentor(s) 14. Departmental Administrator in charge of purchasing: (In the case of dual mentors from differing departments, select one mentor’s department to be in charge of purchasing.) Email:siue.edu Phone: 618-650 15. Special clearances/approvals required for the project Human Subjects Toxic Waste Animal Care Other (Describe) 16. Summary of $500 Project Budget Commodities Contractual Services Student Travel Costs Equipment Other (Specify)
2. SIUE ID# 3. Local Address 4. Permanent Address (if different from above) 5. Telephone Cell Residence 6. E-mail Address @siue.edu For stipend processing information only (your answers will in no way affect your application), please answer the following: 7. Do you have a social security number? (Do NOT provide SSN here.) Yes No 8. Are you a foreign national? Yes No 9. Academic Major 10. Hours Completed 11. GPA (4-point scale) 12. Project Title 13. Mentor(s) 14. Departmental Administrator in charge of purchasing: (In the case of dual mentors from differing departments, select one mentor’s department to be in charge of purchasing.) Email:siue.edu Phone: 618-650 15. Special clearances/approvals required for the project Human Subjects Toxic Waste Animal Care Other (Describe) 16. Summary of $500 Project Budget Commodities Contractual Services Student Travel Costs Equipment Other (Specify)
Associates_Application_CoverPages1.docx