First Name:
Last Name:
e-mail:	sample-applicant@example.com
Birthdate:
Phone Number:	( ) -
Current Address:
City:
State:	AK AL AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY Zip:
Citizenship:	US Citizen Permenant Resident Other - Please Specify   If other, please provide:

Overall GPA:
Present Undergraduate Institution:
Desired Institution for Program:	Florida International University North Carolina State University Pennsylvania State University University of Virginia
Present Undergraduate Major:
Class Standing:	Freshman Sophomore Junior Senior
Expected Graduation Date:

One Page Resume:	File Upload (PDF Format)
Official or Unofficial Transcript:	File Upload (PDF Format) If you do not have a PDF conversion tool you can use one of these free on-line PDF converters PDF Online-PDF Converter. To ensure that your transcripts may be properly included in your application file, please ensure that they are not protected via encryption, a password, a signed certificate or in any other manner.
Letter of Interest:	Letter of Interest indicating an understanding of the ASSIST mission, system, and your future goals as well as linking how past experiences and this research opportunity would help you obtain those goals. File Upload (PDF Format)

Are there any other factors that should be considered when placing you in a specific laboratory or research experience? (e.g. allergies, disability, etc.)
Are you currently working with an ASSIST PI? Yes   No
  If yes, please provide the name of the PI:

From the provided list of research areas, please rank your top 3 choices.	Energy Harvesting Sensors Low Power Devices Energy Storage Electronic Circuits Signal Processing Systems Integration Energy Harvesting Sensors Low Power Devices Energy Storage Electronic Circuits Signal Processing Systems Integration Energy Harvesting Sensors Low Power Devices Energy Storage Electronic Circuits Signal Processing Systems Integration
Check all that apply	I am only interested in Fellowship opportunities I am interested in any opportunity (funded or unfunded) I am interested in working on a group project

These questions are optional. They are not criteria for acceptance, but for Federal reporting and program purposes only.

Gender:	Male Female I choose not to specify
Ethnicity:	Hispanic or Latino Not Hispanic or Latino I choose not to specify
Race:	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White I choose not to specify
Disability Status:	not disabled Disabled Disabled veteran I choose not to specify
Veteran Status:	Served on active duty in the US Armed Forces, Military Reserves or National Guard Training for Reserves or National Guard Only Never served in the military I choose not to specify

I certify that all the information provided in this application is true to the best of my knowledge.