MS PHD'S Mentee Application Form

Thank you for your interest in the MS PHD’S program! We are pleased to announce that we will begin the application process for Cohort IX (2012-2014) of the Minorities Striving and Pursuing Higher Degrees of Success in Earth System Science (MS PHD'S) Professional Development Program! Deadline to submit your online application is August 31, 2012. In addition to the online application, please have two references submit letters of recommendation to pdp@msphds.org by August 31, 2012.

Invited applicants for the 2012 cohort will attend the American Geophysical Union (AGU) Fall Meeting in San Francisco, CA as part of their Phase I experience. To learn more about AGU including student membership rates and benefits, please visit www.agu.org.

MS PHD’S Cohort IX Phase II and Phase III activities will be reserved for evaluation pending federal and private funding for the MS PHD'S initiative.

Please note: You must be a US Citizen or Permanent Resident to be eligible for the MS PHD'S program.

It is recommended that you prepare your responses to these questions in a text editor like notepad and copy and paste your responses into the required fields. You will also need to prepare a resume to include with your application.

If you have problems with the application submission process, please send an email with your contact information to us at pdp@msphds.org. We will contact you as soon as we can.

Personal Information First Name

Middle Initial

Last name

Email

Alternate Email (optional)

Homepage (optional)
http://

Citizenship (you must be a US Citizen or permanent resident to be eligible for MS PHD'S) United States Citizen
Non-U.S. Citizen, Permanent U.S. Resident Visa
Non-U.S. Citizen
Non-U.S. Citizen, Temporary U.S. Resident Visa

Gender Male Female

Please indicate your academic status in the upcoming school year
If other, specify:

Current GPA (e.g.4.0)

Hobbies/interests (optional)

Current Contact Information Street/PO Box

City State

Zip/Postal Code

Country

Phone

Area Code ExchangeLast Four
() -

Contact Information Valid Until Month Year

Permanent Contact Information Check Here and skip this section if same as above

Street/PO Box

City State

Zip/Postal Code

Country

Phone Area Code ExchangeLast Four
() -

Undergraduate Institution Please select your undergraduate institution

If your institution is not included above, enter it here:

Undergrad MajorSecond Undergrad Major (if applicable)

Undergrad Minor

Graduation Date (choose closest month) Month Year

Graduate Institution (if applicable) Please select your graduate institution (if applicable)

If your institution is not included above, enter it here

DegreeMajor

Graduation Date (choose closest month) Month Year

Academic and Research Interests

Disciplinary Specialty Biological
Chemical
Geological
Mathematics
Modeling    If you chose modeling, please specify
Physical
Tech Application/Development   If you chose tech, please specify
Other    If you chose other, please specify

Past research areas and topics (maximum 800 characters including spaces)

Current research areas and topics (maximum 800 characters including spaces)

Future research areas and career goals (maximum 800 characters including spaces)

Diversity Programs
If you participated in other programs designed to increase diversity in STEM fields,
please list name(s) and contact information for each program in which you participated

Program One

Program Name

Program Contact Person

Website address
http://
Phone number

Email address

Program two

Program Name

Program Contact Person

Website address
http://
Phone number

Email address

Program Three
Program Name

Program Contact Person

Website address
http://
Phone number

Email address

Program Four
Program Name

Program Contact Person

Website address
http://
Phone Number

Email address

Experience as a Mentee

Did you have a mentor during your undergraduate/graduate school experience? yes no

If so, what was the most important benefit you received? (optional)

If you did not have a mentor, was it by choice or due to the absence of an appropriate individual who was willing to serve in this capacity?
by choice
due to absence

Your participation in MS PHD'S

Have you participated in the MS PHD'S previously? yes no If yes, which cohort?

Have you participated in any diversity training program? yes no

What strengths do you feel that you bring to the program? (Limit 800 characters including spaces)

How do you see yourself contributing to benefit future MS PHD'S students upon
completion of the program? (Limit 800 characters including spaces)

Provide a brief autobiographical statement that will serve to introduce you to MS PHD'S in Earth System Science staff and mentors (Limit 1500 characters including spaces)

I am willing to provide the following services to other
MS PHD'S in Earth System Science student participants. (Please check all that apply)
Networking assistance
Scientific research advice
Career advice
Career advancement assistance
Assistance in comprehending academic courses
Educational opportunities
Other If you chose other, please specify
Other If you chose other, please specify

I am willing to interact with my mentor face-to-face,
by phone or through the virtual community. (Please check all that apply) Weekly
Bi-weekly
Monthly
Other If you chose other, please specify

Select at least three commitments that you expect your mentor
to make to support the success of your partnership Promptness in response,
Follow-through on assigned tasks
Professionalism/commitment to quality work
Engagement in discussion
Other If you chose other, please specify
Other If you chose other, please specify

List at least one short term and one long term indicator of success
that you will look for to justify your investment of resources and time as a mentee
Short Term (maximum 800 characters including spaces)

Long Term (maximum 800 characters including spaces)

References:

Please have two letters of recommendation from university/college faculty, instructors
and/or research advisors emailed to pdp@msphds.org by the application deadline.
Recommenders should include your name in the subject line of the email.

It is your responsibility to contact your references; we will NOT be contacting references on your behalf!

Recommender 1's name and E-mail Address:

Recommender 2's name and E-mail Address:

IBP works with NSF funded programs around the nation to recruit eligible students to paid internships and fellowships. Please check this checkbox if you do NOT want us to share your contact information with faculty and staff in NSF and NASA programs that support students.

To submit your information and proceed to uploading your resume, please hit 'next.'

MS PHD'S Mentee Application Form

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