Summer Research ProgramApplication

Please complete all sections on this form.
Applicant Name: Email:
Date of Birth:Gender:M F
Academic Status: Student ID #:
Permanent Address:
City:  State:  Zip Code:

Phone:
Campus:
Permanent:
Cell:
Current Address:
City:  State:  Zip Code:

Demographic Information:

Ethnicity:
 
Please check if you are a first-generation college student. (first-generation college students are students whose parents or guardian did not complete a bachelor's degree (from four-year institution of higher education).

U.S. Residency Status

A student must be one of the following to participate in a CRL affiliated research program:

U.S. Citizen
Permanent Resident   
International Student  
Other (please specify):

Please check if you are a returning IU Simon Cancer Center SRP student.

Test Scores

If you graduated from high school in the past two years, you must list your SAT and/or ACT:


Test Verbal/Reading Math Writing Composite
SAT
ACT

Education History

High School Current
Past Enrollment
School:  GPA:
Graduation Date:
College Intended
Current
School:  GPA:
Graduation Date:
Major/Minor:

Please attach an academic transcript in PDF format:

Please provide the date of your final day of classes for spring 2012 session:
Please provide us with a list of honor or advanced courses that you have taken:
Participation in special academic/research activities (e.g. Academic Bowl, Science Fair, Young Scholars, Project Seed):
List your research area(s) of interest:
Awards, honors, scholarships or grants you have received:  N/A
Extracurricular Activities:  N/A

References

(At least one reference should be from a faculty member. If you have research experience, please include a recommendation from a research supervisor.)


Reference 1
Name: School:
Position:     
Email: Phone:

Reference 2
Name: School:
Position:     
Email: Phone:

Reference 3
Name: School:
Position:     
Email: Phone:

Personal Statement

Please attach a personal essay describing your reasons for applying to this program. Explain how your participation in this research program will enhance your potential to achieve your academic and career goals. The paper should be typed, double spaced, with standard margins, 11 or 12 pt. Times New Roman or Arial font, and no more than two pages.

Personal Statement:


BY CHECKING THIS BOX, I HEREBY AFFIRM THAT ALL INFORMATION IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE.

Student Name:  Date:
 
How did you learn about this research program?