P.E.C.O.P Application - College of Agriculture Food and Natural Resources

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email*

Enter Email Confirm Email

Demographic Information

Citizenship Status*

U.S. Citizen
Permanent Resident
Other

Gender*

Male
Female

Ethnicity

American Indian/Alaska Native
Black/African American
Latino/Hispanic
Asian
White/Caucasian
Native Hawaiian or Other Pacific Islander

Age

Academic Information

Which university are you enrolled at?

Current Major*

Current GPA*

Classification*

Any prior research experience?

Yes
No

Are you planning to enroll in courses during the summer?

Yes
No

Are you interested in attending graduate school?*

Yes
No

Provide one page essay describing your research interests, career goal and related experience (no more than 3000 characters including space)*

Max. file size: 50 MB.

Personal Information

Have you been convicted of a crime involving acts of violence or sexual misconduct including, but not limited to, criminal homicide: murder or non-negligent manslaughter; sexual assault: rape, fondling, incest, or statutory rape; robbery; aggravated assault; arson; simple assault; destruction/damage/vandalism or property; domestic violence; or stalking? (Juvenile adjudications are not required to be reported)

Yes
No

Do you have any past substantiated or pending conduct charges involving acts of violence or sexual misconduct including, but not limited to, criminal homicide: murder or non-negligent manslaughter; sexual assault: rape, fondling, incest, or statutory rape; robbery; aggravated assault; arson; simple assault; destruction/damage/vandalism of property; domestic violence; dating violence; or stalking?

Yes
No

Have you been expelled or suspended from a post-secondary institution?

Yes
No

Are you currently vaccinated for Hepatitis A, Hepatitis B, and Tetanus?

Yes
No

Additional Application Requirements

Please provide a copy of your resume*

Max. file size: 50 MB.

Please provide a copy of your current transcript*

Max. file size: 50 MB.

Please provide two letters of recommendations*

Drop files here or

Max. file size: 50 MB.

Agreement: I understand that all participants in this PECOP Fellowship program are required to participate in minimum 20 hours of extension, research and education related activities per week during the 12-week program. I hereby certify the information provided is accurate to the best of my knowledge. If accepted, I agree to obey all the rules and regulations guiding this PECOP Fellowship program and diligently undertake all assigned tasks. I understand that failure to comply with the above terms and conditions may result in my disqualification and/or termination from the PECOP Fellowship program.

Signature: First and Last Name*

Date*