Name:
First: Last
Your College or University:
Class:
Freshman
Sophomore
Junior
Senior
Postbac
Not a student
When do you plan to
graduate?
Fall 2009
Winter 2010
Spring 2010
Summer 2010
Winter 2011
Spring 2011
Summer 2011
Fall 2011
Winter 2012
Spring 2012
Summer 2012
Later
What is your major?
Biology
Biochemistry
Cell Biology
Chemistry
Computer and Information
Science
Development
Ecology
Environmental
Studies/Sciences
Evolution
Exercise and
Movement Studies
General Science
Genetics
Geography
Geology
Human Physiology
Marine Biology
Microbiology
Molecular Biology
Mathematics
Neuroscience
Physics
Physiology
Psychology
Other
If "Other",
please specify:
If you transferred from
another institution, please list:
E-mail Address:
Phone Numbers:
Cell:
Home: Other: (if
preferred)
Current Address:
Permanent Address:
Date of Birth:
(MM/DD/YY)
Citizenship:
US Citizen
Permanent
Resident with Green Card
Permanent
Resident awaiting Green Card
Not US Citizen
Gender:
Male Female
Race/Ethnic Background:
Hispanic
Non-Hispanic Black
Non-Hispanic White
Native
American or Alaska Native
Asian
Pacific Islander
Other
Decline response
Do you claim disadvantaged
status ?
No
First generation to attend college
Low Income
Other or multiple- Please explain
If "Other or multiple", please explain
How did you learn about our Summer Program?
Internet search
ABRCMS meeting
SACNAS meeting
College advisor
Mailing or poster
Other
Are you currently a MARC
scholar?
MARC: Minority Access to
Research Careers
Yes
No
Have you been MARC scholar
in the past?
Yes
No
Do your career goals
inlude an advanced degree?
Yes, PhD
Yes, MD
Yes, MD and PhD
Unsure, possibly PhD
Other Professional Degree, e.g., DDS,
DVM, etc
Unsure
No
If "Other", please specify
Do your career development
goals include research in life sciences?
Yes
No
Unsure
What dates would you be
available to participate in the program?:
What is your approximate cumulative GPA?
What is your approximate science/math GPA?
Please submit the following information in
the fields below:
A: Describe your academic background, scientific
interests, goals, and past research experience (if any). Include
significant science courses you have taken and specific laboratory
techniques you may have used.
B: Why do you want to participate in a Summer research
experience? Explain what you hope to gain from the Summer
experience and how it will help you pursue your career and personal
goals.
C: Indicate your area(s) of research interest for
the Summer Program:
1st Choice:
Biology
Biochemistry
Cell Biology
Chemistry
Computer and Information
Science
Development
Ecology
Environmental
Studies/Sciences
Evolution
Exercise and
Movement Studies
General Science
Genetics
Geography
Geology
Human Physiology
Marine Biology
Microbiology
Molecular Biology
Mathematics
Neuroscience
Physics
Physiology
Psychology
Other
Relative Importance:
High
Medium
Low
2nd Choice :
Biology
Biochemistry
Cell Biology
Chemistry
Computer and Information
Science
Development
Ecology
Environmental
Studies/Sciences
Evolution
Exercise and
Movement Studies
General Science
Genetics
Geography
Geology
Human Physiology
Marine Biology
Microbiology
Molecular Biology
Mathematics
Neuroscience
Physics
Physiology
Psychology
Other
Relative Importance:
High
Medium
Low
3rd Choice:
Biology
Biochemistry
Cell Biology
Chemistry
Computer and Information
Science
Development
Ecology
Environmental
Studies/Sciences
Evolution
Exercise and
Movement Studies
General Science
Genetics
Geography
Geology
Human Physiology
Marine Biology
Microbiology
Molecular Biology
Mathematics
Neuroscience
Physics
Physiology
Psychology
Other
Relative Importance:
High
Medium
Low
If "Other", please specify:
Other Choice:
D: (Optional) Please give a more
detailed description of your
research interests: Are your interests broad? Have you narrowed
them? Do you have defined interests in several areas?
E: After visiting the University of Oregon
UO-REU
link describing participating laboratories, please list
laboratories for which you might have a preference (if any) .
F: Describe your outside interests and activities:
(optional)
G: Paste your Unofficial Transcripts here (as
neatly as possible ):
H: Please arrange for two letters of
reference from faculty at your home institution to be sent by email
(preferred) to uo-reu@uoneuro.uoregon.edu
or, if necessary, letters can be sent by ground mail to the address at
the end of this page.
Who will
submit recommendation letters for you?
Faculty reference 1
Name; Department; Institution:
email:
Faculty reference 2
Name; Department; Institution:
email: