Summer Undergraduate Research Program Application

This form contains essay questions.
We suggest you complete those in a word processor first and then copy & paste them into the form. Please limit your essays to 250 words each.
Submission of this form is final.

Contact: Debbie Shoemaker, shoemakd@musc.edu, 843-792-9620
Deadline: Extended to March 1, 2009

* = required

First Name *   MI Last Name *
Date of birth* (mm/dd/yyyy) Sex*
SSN Although you are not required to submit your SSN, please note that failure to do so could cause delay in receiving stipend payments, should you be accepted.
School Mailing Address
Address *
City *
State *
Zip *
Permanent Mailing Address
Address *
City *
State *
Zip *
Phone * Alternate Phone
Email * Alternate Email
Citizenship *
If not a US Citizen, of which country are you a citizen? *
If you have a permanent resident alien "green" card, please provide the number on the card: *
Ethnicity Are you Hispanic (or Latino)? *
What is your racial background? *
Background Are you from a disadvantaged background? *
If yes, please answer these questions:
Do you come from a family with an annual income below established low-income thresholds? *
(Individuals falling in this category must have qualified for Federal disadvantaged assistance or have received Health Professional Student Loans (HPSL), Loans for Disadvantaged Student Program, or scholarships from the U.S. Department of Health and Human Services under the Scholarship for Individuals with Exceptional Financial Need.)
Do you come from an environmentally disadvantaged background? *
(ex: Individuals who last attended a high school from which a low percentage of seniors receive a high school diploma; individuals receiving public assistance; Individuals who come from a school district where 50% or less of graduates go to college/or where college education is not encouraged; Individuals who are the first generation to attend college and who are from a rural areas/public assistance;.)
Disability Do you have a disability? *
If yes, which of the following categories describe your disability(ies)?
References Two faculty references are required. In this space, please provide the names, titles and departments of the faculty members from whom you are requesting references: *
Educational Background Beginning with the institution you are currently attending, please list the colleges/universities/high school you have attended. (at least one is required) *
Name & location of school Major Expected Degree & Graduation Date Overall GPA
Availability and housing Can you start on June 1, 2009? *
Are you available to participate until Aug 7, 2009? *
Please indicate your housing arrangements should you be accepted: *
Research interests Please select your top four research interests:
1) *
2) *
3) *
4) *
Goals What are your educational goals? *
What are your Career Goals? *

Essays

Why are you applying to the MUSC Summer Undergraduate Research Program? (Limit 250 words) *

What are your career goals? (Limit 250 words) *

How will this experience help you meet these goals? (Limit 250 words) *

Describe any past experiences that have led you to your interest in research and in specific areas of research offered at MUSC. (Limit: 250 words) *