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Lemelson-Caltech Student Prize
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Step 1: provide your name and contact information.
Fields marked with an asterisk * are required.
The Basics
First Name*
Middle Initial 
Last (Family) Name*
Last Four Digits of UID Number*
Email Address*
Country of Citizenship*
Country of Permanent Legal Residence*
Academic Affiliation and Status
Academic status in spring term* Undergraduate Graduate student
Division 
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Street 1 *
Street 2  
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Zip Code*
Please provide at least one phone number that we may use to reach you.
Home Phone 
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How did you hear about the Lemelson-Caltech Student Prize?
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Other:
Caltech is required to record ethnic/racial and gender data as part of the reporting requirements of the Lemelson Prize. We therefore are requesting that you please provide the following information. Refusal to do so will not result in any adverse action on your submission. This information is confidential and will be communicated only as permitted by applicable law.
Gender: Male     Female 
Ethnicity: Are you Hispanic or Latino? All persons of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or orgin, regardless of race.

Yes     No 

American Indian or Alaskan Native:
(Not Hispanic or Latino) All persons having origins in any of the original peoples of North, Central or South America and who maintains a tribal affiliation or community attachment
Asian (Not Hispanic or Latino) All persons having origins in any of the original peoples of the Far East, Southeast Asia, or Indian Subcontinent
Black (Not Hispanic or Latino)
All persons having origins in any of the Black racial groups of Africa.
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
All persons having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands
White (Not Hispanic or Latino)
All persons having origins in any of the original peoples of Europe, the middle East or North Africa
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the five non-Hispanic or Latino races listed above
I prefer not to provide any of the information contained in this self-identification form

 

Caltech    last update: 11/05/2009