NIEHS/UC Davis Superfund Basic Research and Training Program

Fellowship Application Questionnaire

Instructions: Complete the following and include with your application. Please print clearly.

Note: All graduate students must file a Free Application for Federal Student Aid (FAFSA). You may file a FAFSA via the web at http://www.fafsa.ed.gov. If you do not have access to the web, contact the UC Davis Financial Aid Office at 530-752-9246 or visit their office in Dutton Hall.

Name

Student ID Number

Home Address

City, State, Zip

Home Telephone

Whose lab do you work in/will you be working in?

Graduate Group

What year of study are you in currently?

Campus Address

Campus Telephone

E-mail Address

Yes No

Have you filed a Free Application for Federal Student Aid (FAFSA) form?

(THIS IS REQUIRED TO DETERMINE WORK STUDY ELIGIBILITY.)

Are you a U.S. citizen?

Are you a permanent resident?

Are you a California resident?

Are you an international student?

Are you subject to nonresident tuition?

When will you/did you advance to candidacy? (indicate quarter or date)

I am applying for: Graduate Student Researcher fellowship

Non Resident Tuition Remission Waiver

Both the Graduate Student Researcher fellowship and Non Resident Tuition

Remission Waiver

Technology Transfer fellowship