Please print this page out from your browser and mail to:
Francoise Freyre, M.A.
Assistant Dean
Joan and Sanford I. Weill Cornell Graduate School of Medical Sciences
445 East 69th Street, Room 412, New York, NY 10021
Phone: 212-746-6120
Fax: 212-746-8906
Deadline for Receiving Application: February 1
PERSONAL INFORMATION
Name:
Male [ ] Female [ ]
Social Security No.:
Date of Birth:
Citizenship: U.S. Citizen_____ Permanent Resident of U.S._____
Permanent Address:
Current Address:
Telephone:
E-mail address:__________________________________
EDUCATION:
College:
Year in School:
Address:
Major:
Minor:
Overall GPA:
Science GPA
List all science courses completed/or in process (use additional page, if necesary):
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How did you find out about this program?_______________________________________________________________
Have you participated in any summer research program(s)?______ If so, list program(s)
Are you applying to other programs this summer? Yes [ ] No [ ]
If yes, would you volunteer name(s):
If you are accepted into this program, would you require on-campus housing? Yes [ ] No [ ]
RESEARCH EXPERIENCE:
Please describe any research experience you may have. Include projects you have done for your science courses.
IN WHAT AREAS OF STUDY ARE YOU MOST INTERESTED?
___Biochemistry and Structural Biology ___Cell Biology and Genetics
___Immunology ___Molecular Biology
___Neuroscience ___Pharmacology
___Physiology and Biophysics
ESSAY(500 Words):
On a separate page please state why you want to participate in this summer research program and also indicate what are your short and long term career goals.
