SURP Student Information Form

UAMS SURP to Increase Diversity Student Information

Please complete the information below so that we can begin planning for the upcoming summer.
  • Name * Required
  • Permanent Address
  • Current Address (if different from permanent)
  • Date Format: MM slash DD slash YYYY
  • Emergency Contact Name * Required
  • Summer mentor

    Please list the names of three faculty you are interested in conducting research with in order of preference. We will make every attempt at matching you with a faculty member you are interested in, but we will select another mentor if they are not available.
  • Housing

    Dormitory housing is available only for students that do not have a permanent residence in the Greater Little Rock metropolitan area.
  • Will you require housing for the summer? * Required
    If you answer yes, please complete the questions below.
  • Only answer if need housing.
  • Only answer if need housing. Parking is very limited on campus. You can apply for parking when you arrive.