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 100 words each.
Submission of this form is final.

Contact: Debbie Shoemaker, shoemakd@musc.edu, 843-792-9620
Deadline: January 31, 2010

* = required

First Name *   MI Last Name *
Date of birth* (mm/dd/yyyy) Sex*
SSN Participants are asked to voluntarily provide their Social Security Numbers. This information provides us with necessary information to ensure timely payment of stipends and paychecks with fewer delays.
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? *
References Please request references from two individuals familiar with your work in a laboratory setting (faculty members, mentors, etc...). If this is your first laboratory experience, request the references from two faculty members. Provide the names, titles and departments of the faculty members from whom you are requesting references in the space below. *
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 Are you available to participate from June 7, 2010 continuously until August 13, 2010? *
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 100 words) *

What are your career goals? (Limit 100 words) *

How will this experience help you meet these goals? (Limit 100 words) *

Describe any past experiences that have led you to your interest in research and in specific areas of research offered at MUSC. (Limit: 100 words) *