California State University, Los Angeles

Partnership for Research and Education in Materials

PREM
Student Fellowship Application

Application Checklist:
 Completed Application Form (this document)
 Statement of Intent
 Two letters of recommendation (hard copy, on college/university letterhead, and signed)
 Official transcripts from all colleges/universities attended
 Resume/CV

Thank you for applying to the PREM at California State University, Los Angeles.
Please complete this application in its entirety and return, along with the corresponding materials mentioned
above.

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Personal Information:

Name: ______________________________________________________________________________________
Last First MI

Address: _____________________________________________________________________________________

City: ___________________________________________ State: ___________ Zip: _________________________

Email address:____________________________________ Telephone: _(______)________-__________________

U.S. Citizen: Yes ____ No _____ Permanent Resident (registration number) ______________________________

Social Security Number: _________________________ CSULA Campus ID Number: _______________________

Ethnicity*: (check one)______ American Indian/Alaskan Native ______ Caucasian/White, non-Hispanic

______ Asian/Pacific Islander ______ Other (specify) ___________________

______ Black, non-Hispanic ______Unknown

______ Hispanic/Chicano(a)/Latino(a)

Gender*: __________________________

* We are required to request this data. You are not obligated to provide this information.

Education:
Current or highest completed degree: (check one)

______High school diploma ______Ph.D./Sc.D.

______B.S. ______Other (specify) ___________________

______M.S./M.A./M.Eng.

Institution: ____________________________________________ Anticipated graduation date: _____________

Major: ___________________________________________

GPA in last 60 semester or 90 quarter units:______________ Current Overall GPA: _____________________

Quarter for which applying:  Fall  Winter  Spring  Summer Year______________________

If you are currently a CSULA student, initial in the space provided if you give the Center for Energy and
Sustainability permission to access your academic records through GET ________.

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 Statement of Intent:

Please provide a statement of intent in standard format (Times font, 12 point, double spaced)
answering the two questions below.

1) Research Statement: Please submit a statement of your past research experience and future
objectives. Be specific with respect to the actual research projects you would like to join. If
necessary or appropriate, please identify faculty member(s) with whom you’d like to work.
Limit: 1,000 words.

2) Career Objectives: Please submit a statement of career objectives indicating what your career
goals are. Please note that priority is given to students who want to continue their education
towards the doctorate. If this is your plan, tell the committee why and be specific about how
you will go about continuing onto a Ph.D. program and what your eventual career goals are. If
necessary or appropriate, please identify the Ph.D. programs you’d like to enter. Limit: 500
words.

I hereby certify that all of the information furnished on this application and during the application process is
true, complete, and accurate to the best of my knowledge.

Signature: ______________________________________________ Date: ____________________

Thank you for applying to the PREM Fellowship at California State University, Los Angeles.

Partnership for Research and Education in Materials

California State University, Los Angeles
5151 State University Drive, LIB N 2026A
Los Angeles, California 90032-8970
URL: http://calstatela.edu/prem

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