LSRIP 2014

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Captcha ^✻ What is 6 + 5?

Labor Summer Research Internship Program

Also known as LBR&WS 194A and 195A

Last (Family) Name: ^✻

First (Given) Name: ^✻

Middle Name:

Gender ^✻

Birthdate: ^✻

(DD/MM/YYYY)

Phone Number: (best number to contact you directly) ^✻

XXX-XXX-XXXX

E-mail: ^✻

please provide an e-mail address that you check often

Present School: ^✻

Please provide the full name of your current school

If you indicated UCLA as your present school, please provide your student ID

How many years of undergraduate education have you completed post High School ^✻

What will your class level be in Fall 2015: ^✻

Major: ^✻

Are you an international student? ^✻

Will you be applying for Financial Aid? ^✻

Do you have a Baccalaureate degree (BA/BS): ^✻