1. 2012 ALGEBRA RELAY
Wednesday, April 4, 2012
Sponsored by
Office of Undergraduate Research (DUROP Series)
in collaboration with the Department of Mathematics
ENTRY FORM
This form is to be completed and signed by faculty mentors. Additional information will be forwarded
to the faculty mentor upon receipt of the entry form.
FACULTY MENTOR or MENTOR ASSISTANT: _____________________________________________
(Signature)
Division _______________________ Teleph _________________ E-Mail _______________________
STUDENT NAMES:
1. _______________________________________________________ ID________________________
E-Mail ____________________ Tel ____________________ Major ___________________________
Grade Level (check one) Frosh ( ) Soph ( ) JR ( ) SR ( )
2. _______________________________________________________ ID________________________
E-Mail ____________________ Tel ____________________ Major ___________________________
Grade Level (check one) Frosh ( ) Soph ( ) JR ( ) SR ( )
3. _______________________________________________________ ID________________________
E-Mail ____________________ Tel ____________________ Major ___________________________
Grade Level (check one) Frosh ( ) Soph ( ) JR ( ) SR ( )
4. _______________________________________________________ ID________________________
E-Mail ____________________ Tel _____________________ Major __________________________
Grade Level (check one) Frosh ( ) Soph ( ) JR ( ) SR ( )
5. _______________________________________________________ ID________________________
E-Mail ____________________ Tel _____________________ Major __________________________
Grade Level (check one) Frosh ( ) Soph ( ) JR ( ) SR ( )
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2. DUUROP Series – 2012 Algebra Relay Entry Form Page 2
STUDENT TEAM MEMBERS
Student #1 Name (Captain) _____________________________________________________
a) Are you currently involved in a research project? □ Yes □ No
b) If yes, who is your Research Mentor and what is your research title?
____________________________________________________________________________
Student #2 Name _____________________________________________________________
a) Are you currently involved in a research project? □ Yes □ No
b) If yes, who is your Research Mentor and what is your research title?
____________________________________________________________________________
Student #3 Name_____________________________________________________________
a) Are you currently involved in a research project? □ Yes □ No
b) If yes, who is your Research Mentor and what is your research title?
____________________________________________________________________________
Student #4 Name_____________________________________________________________
a) Are you currently involved in a research project? □ Yes □ No
b) If yes, who is your Research Mentor and what is your research title?
____________________________________________________________________________
Student #5 Name _____________________________________________________________
a) Are you currently involved in a research project? □ Yes □ No
b) If yes, who is your Research Mentor and what is your research title?
____________________________________________________________________________
FACULTY MENTOR
Feel free to address any questions concerning the Algebra Relay in the space below.
Questions/concerns will be covered at a workshop sponsored by the Office of Undergraduate
Research prior to the event.
Mentor or Assistant Signature: ______________________ Tel __________ Date __________
(Mentor’s signature indicates approval of the students’ participation in the Algebra Relay and agreement that he/she
is willing to prepare students for the competition in accordance with competition rules.)
Return completed entry form to
Office of Undergraduate Research
Professional Schools Bldg., Rm. 250 * lstrong@dillard.edu * 504-816-4446
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DUROP:10/12