Kearney Foundation of Soil Science

Undergraduate Student Fellowship

Email: kearney@ucdavis.edu

Telephone: (530) 754-9668

Fax # 530 752-2360

Student Information Form

Project Title:

Applicant:

Name: (last name, first name, middle name)

Department

Program

Campus

Campus/Department Address:

Street Address

Room/Building

City State Zip

Telephone Fax

Email

Signatures:

Applicant: _______________________________ Date: ________

Mentor:___________________________________ Date: ________

Mail or fax the Student Information Form with signatures to the following address:

LAWR/Kearney Foundation

Attn: Gladis Lopez

University of California

Davis, CA 95616

Fax # 530 752-2360

Note: Your application will not be considered complete until we receive this signed form along with all the required documents.

UC Faculty Member Nomination Form

Applicant’s Name: (last name, first name, middle name)

Mentor Professor:

Name (last name, first name, middle name)

Title

Department

Campus

Campus/Department Address:

Street Address

Room/Building

City State Zip

Telephone Fax

Email

Attach a letter of support for the student.