Mississippi INBRE Scholars Program Housing Assistance Application

Name(Required)

Prefix First Middle Last

Suffix

Academic Email(Required)

Phone(Required)

Home Institution(Required)

Mentor Name(Required)

First Last

Mentor Email(Required)

Visiting/Mentor Institution(Required)

What institution is your mentor's lab located at?

Permanent Address(Required)

Street Address Address Line 2 City State ZIP Code

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Where are you planning to live this summer?(Required)

Current Address

Permanent Address

Airbnb

Sublet Apartment

Other

Distance from planned residential city/town/community/municipal area to visiting city/town/community/municipal area(Required)

In miles

Please upload a screenshot of the distance between the planned residential and visiting areas on Mapquest.(Required)

Use the following link: https://www.mapquest.com/directions

Drop files here or

Accepted file types: jpg, png, Max. file size: 300 MB.

Justification for Funds(Required)

Please describe your need for housing assistance (500 words max).

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.