.

A. Personal And Background Information
*Name	firstmilast
*Gender:	Male Female
*Residency:	U.S. Citizen Naturalized
Naturalization Number:
Permanent Mailing Address
E-Mail Address:
Telephone:
Address:
City, State ZIP	city Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming statezip
*County	-- Select County -- (select state first)
*Congressional District:
	Click here for help finding your congressional district.
Student Mailing Address at University (if different from above)
*E-Mail Address:
*Telephone:
*Address:
*City, State ZIP	city Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming statezip
* Race/Ethnicity
Central American Cuban Dominican Mexican American Puerto Rican South American Spanish White/Anglo Black/African American Asian/Pacific Islander   Native American/American Indian   --  Tribal Affiliation Other

B. Academic Information
*I am a:	Undergraduate Student Graduate Student
*Classification:	Sophomore Junior Senior
*Current College/University	Select University
*Major Field of Study:
Minor Field of Study:
*Credit Hours Completed:
*GPA (On a 4.0 Scale):
*Expected Graduation Date:
*Did you transfer from a community college?:	Yes No
If you are attending a community college, do you intend to transfer to a 4-year college or university?:	Yes No
If yes, which college/university?	Select University
Including the current year, how many years did you attend a community college?:
*Classification:	Masters Post-Docs
*Current College/University	Select University
*Major Field of Study:
Minor Field of Study:
*Credit Hours Completed:
*GPA (On a 4.0 Scale):
*Expected Graduation Date:

C. MAES/SACNAS/SHPE Background
*Are you a SHPE member?:	Yes No
*I have been a SHPE member for at least
Less than 3 months 3 months 6 months 12 months 2 years 3 years 4 years 5 years More than 5 years
*Are you a MAES member?:	Yes No
*I have been a MAES member for at least
Less than 3 months 3 months 6 months 12 months 2 years 3 years 4 years 5 years More than 5 years
*Are you a SACNAS member?:	Yes No
*I have been a SACNAS member for at least
Less than 3 months 3 months 6 months 12 months 2 years 3 years 4 years 5 years More than 5 years

D. NNSA Labs/Research Interests
Please choose your top 3 NNSA site preferences. Aiken, SC Albuquerque, NM Headquarters-Germantown, Maryland Headquarters-Washington, D.C. Kansas City Site Office, MO Las Vegas, NV Lawrence Livermore National Laboratory-Livermore, CA Livermore, CA Los Alamos National Laboratory-Los Alamos, NM Los Alamos, NM Oak Ridge, TN Pantex Site Office-Amarillo, TX Sandia National Laboratory-Albuquerque, NM *There is no guarantee that students will be placed at their preferred sites.
Please choose your top 3 research interests. Aerospace/Aeronautics Eng Biological Science Biomedical Chemical Eng Chemsitry Computer Eng/Science Electronics/Electrical Eng Environmental Eng/Science Industrial Eng Integration Engineering Life Science Materials Eng Mathematics Mechanical Eng Metallurgy Physical Science Physics Structural Eng Systems Eng
Have you previously participated in a National Nuclear Security Administration/Department of Energy program?	Yes No (if no, skip to Section E)
Program Name:

* E. Personal Statement

Please include a succinct personal statement which uniquely addresses why you are interested in working with NNSA Headquarters, labs or sites and your NNSA-related research interests/goals. Please include as much information on your background as possible. Include such elements as challenges you have overcome, family background, community involvement, leadership, academic achievement(s), research/internship/co-op experience(s), and short-term and long-term goal(s) and aspiration(s). Be sure to include any information you feel the internship review committee should consider when reviewing your application. Essay should be at least 250 words and no more than 1000 words.

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