2003 Journal -- Application

 

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APPLICATION AND MANUSCRIPT SUBMISSION FORM
Click Here for the MS Word Version


THE UCI UNDERGRADUATE RESEARCH JOURNAL

A multi-disciplinary publication of exceptional
research papers completed by UCI undergraduates

If you have any questions, please contact the UROP office in Student Services II, Suite 2300
Phone: (949) 824-4189     E-mail: urop@uci.edu     URL: http://www.urop.uci.edu

DEADLINE TO SUBMIT APPLICATION AND MANUSCRIPT: MONDAY, JUNE 30, 2003

Please type or print clearly in blue or black ink. Please feel free to make copies as needed. Incomplete applications will not be considered.

  Project Information

TYPE OF PROJECT:  box.jpg (3050 bytes) Independent Research/Creative Project     box.jpg (3050 bytes) Group Research Project

Does this project involve the student's use of human subjects or data/specimens from living humans?    box.jpg (3050 bytes) YES   box.jpg (3050 bytes) NO
If yes, please provide the approved IRB protocol number: _______ (Note: student's name must be listed on protocol)

Does this project involve the use of live vertebrate animals?   box.jpg (3050 bytes) YES   box.jpg (3050 bytes) NO
If yes, please provide the approved IACUC protocol number: _______ (Note: student's name must be listed on protocol)

Area of Research: underline.gif (44 bytes)

Manuscript Title:   underline.gif (44 bytes)

 

  Researcher(s) Information    
        (Please attach information for additional group members, if applicable)

NAME (last, first, middle): underline.gif (44 bytes) 

STUDENT ID:  underline.gif (44 bytes)

MAJOR(S): underline.gif (44 bytes)  E-MAIL: underline.gif (44 bytes)

LOCAL ADDRESS

Street:  underline.gif (44 bytes)

City: underline.gif (44 bytes)     State: underline.gif (44 bytes)
Zip: underline.gif (44 bytes)

Phone: (     ) underline.gif (44 bytes)

 

PERMANENT ADDRESS

Street:  underline.gif (44 bytes)

City: underline.gif (44 bytes)     State: underline.gif (44 bytes)
Zip: underline.gif (44 bytes)

Phone: (     ) underline.gif (44 bytes)

 

  ON- AND OFF-CAMPUS FACULTY MENTOR(S) INFORMATION
        (Please attach information for additional faculty mentors, if applicable)
 

NAME(last, first, middle): underline.gif (44 bytes)

UCI ADDRESS: underline.gif (44 bytes)

OFF-CAMPUS ADDRESS:(only for non-UCI mentors):
Street underline.gif (44 bytes)

DEPARTMENT: underline.gif (44 bytes)

PHONE: underline.gif (44 bytes) E-MAIL: underline.gif (44 bytes)

 

City underline.gif (44 bytes) State underline.gif (44 bytes) Zip underline.gif (44 bytes)

FACULTY MENTOR SIGNATURE* (required): underline.gif (44 bytes)
DATE: underline.gif (44 bytes)

My signature above affirms that I have reviewed and approved the attached manuscript for submission to publish in The UCI Undergraduate Research Journal, and I hereby indicate my support for the publication and reproduction of the manuscript by UROP.

*In the event of publication, you will be contacted for further information regarding this project.

  LIABILITY RELEASE CERTIFICATION

My signature hereby certifies that all references, citations, quotations, images, tables, illustrations, charts, diagrams, and graphs are accurate and have been properly credited. My signature also certifies that, where applicable, I (we) have obtained written permission from the copyright owner to publish all references, citations, quotations, images, tables, illustrations, charts, diagrams, and graphs or parts thereof contained in their original work in The UCI Undergraduate Research Journal. My signature further agrees to indemnify and hold harmless The UCI Undergraduate Research Journal or UROP from any and all liability resulting from a breach of this certification.

SIGNATURE OF AUTHOR(S) :  underline.gif (44 bytes) 
DATE: 
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