SURP 2021 Application Form

SURP Application Form

Please complete the application below. The deadline for receipt of all application materials is February 15, 2021. Students who have graduated prior to June 2021 are not eligible for the program. In addition to the application, the SURP requires two letters of recommendation from faculty and copies of your transcripts. Please contact Dr. Latrina Prince at with any questions.
  • Name * Required
  • Permanent Address * Required
  • Current Address (if different than permanent address)
  • Email * Required
  • Optional: Have either of your parents (or guardians) graduated from a four-year university?
  • Optional: Are you a member of a disadvantaged group (factors that affect disadvantaged status could be social, economic, and/or educational)?
  • Are you currently participating in a federally funded program (ex. McNair, RISE, IMSD)? * Required
  • You can upload copies of your transcripts here. You may also mail them to Dr. Latrina Prince.
  • I waive my rights to view my letters of recommendation pursuant to the Family Educational Rights and Privacy Act. . * Required