2021 Fields Undergraduate Summer Research Program (FUSRP) - Student Application

Thank you for your interest in the 2021 Fields Undergraduate Summer Research Program!

Please note this application form contains three parts: Personal Information, College/University Information, and Reference Information. All three pages must be completed in order for your application to be considered.

FUSRP 2021 will be conducted in person (until further notice).

The deadline to submit your application is January 24, 2021 at 11PM (EST).

1. Personal Information

First Name *This question is required.

Middle Name

Last Name *This question is required.

Gender (used for anonymous reporting purposes in order to improve access to programming) *This question is required.

2. Contact Information

Current Mailing Address *This question is required.

Apt/Suite/Office

City *This question is required.

Province/State *This question is required.

Postal Code/Zip

Country *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone Number

Mobile Phone

3. Citizenship *This question is required.

Current Citizenship

Date of Birth (DD/MM/YYYY) *This question is required. This question requires a valid date format of DD/MM/YYYY.

calendar

4. Have you previously participated in the Fields Undergraduate Student Research Program? *This question is required.