Kearney Foundation of Soil Science

Undergraduate Student Fellowship

Telephone: (530) 754-9668

Fax # 530 752-2360

Student Information Form

PROJECT TITLE:
APPLICANT INFORMATION
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: V.Ana Balogh

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
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:

Please attach a letter of support for the student.