DU 2012 Algebra Relay Entry Form

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DU 2012 Algebra Relay Entry Form

  1. 1. 2012 ALGEBRA RELAY Wednesday, April 4, 2012 Sponsored by Office of Undergraduate Research (DUROP Series) in collaboration with the Department of MathematicsENTRY FORMThis form is to be completed and signed by faculty mentors. Additional information will be forwardedto 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 ( ) 1
  2. 2. DUUROP Series – 2012 Algebra Relay Entry Form Page 2STUDENT TEAM MEMBERSStudent #1 Name (Captain) _____________________________________________________a) Are you currently involved in a research project? □ Yes □ Nob) 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 □ Nob) 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 □ Nob) 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 □ Nob) 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 □ Nob) If yes, who is your Research Mentor and what is your research title?____________________________________________________________________________FACULTY MENTORFeel 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 UndergraduateResearch 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/sheis 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 2 DUROP:10/12

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