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Student Application

Fields in Red are required.

Mentor (if known): Email: Z#:

Student Information

Title: Last Name: First Name:

Student type:

Dates of Visit: to (MM/DD/YYYY)

Citizenship: Dual Citizenship: (if applicable)

Institution/Affiliation: Contact Phone:

Contact Fax: Contact Email:

Brief description of student's proposed research - If you are an undergraduate, please include relevant classes completed.

Required Documents to Include
pdf,ps,odt, or doc files only
Student's CV:

Employment Status (Ask Kacy if clarification of the differences is needed.)
Will this student be at LANL as an Employee or a Visitor ?
Employees are hired by LANL.
Visitors have their expenses paid by their university, fellowship, etc.

Additional Information