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To the Student: Please print your name in the space below. Sign and date this form and then submit it to your guidance office.

Student ______________________________________________________

To the Guidance Counselor: The student listed above is applying to participate in the High School Research Program at Brookhaven National Laboratory. Please forward a recent transcript of the student's academic record to the address below.

Scott Bronson
High School Research Program
Brookhaven National Laboratory
Science Education Center, Bldg. 438
P.O. Box 5000
Upton, NY 11973-5000

This is to certify that I wish to forward my transcript to Brookhaven National Laboratory in support of my High School Research Program application.

Student's Signature _______________________________________________________

Date ___________________

Last Modified: January 31, 2008
Please forward all questions about this site to: Sarah Maine

One of ten national laboratories overseen and primarily funded by the Office of Science of the U.S. Department of Energy (DOE), Brookhaven National Laboratory conducts research in the physical, biomedical, and environmental sciences, as well as in energy technologies and national security. Brookhaven Lab also builds and operates major scientific facilities available to university, industry and government researchers. Brookhaven is operated and managed for DOE’s Office of Science by Brookhaven Science Associates, a limited-liability company founded by Stony Brook University, the largest academic user of Laboratory facilities, and Battelle, a nonprofit, applied science and technology organization.

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