Summer Research Program Application

Please complete all sections on this form.

Contact Information

F

City:   State:   Zip Code:
Same as above

City:   State:   Zip Code:

Demographic Information

Please check all that apply:

American Indian or Alaskan Native
Asian or Pacific Islander
Black or African American
Hispanic/Latino
White
I'd prefer not to disclose this information

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

Returning Student

Please check if you are a returning IU Simon Cancer Center SRP student.
Year of previous participation:

How would you benefit from another year in this program?

Test Scores

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


  Verbal/Reading Math Writing Composite
SAT
ACT

Education History

High School Currently Enrolled Graduate/GED
School:  GPA: GPA Scale:
Graduation Date:
College Exploring Intended Currently Enrolled

Please check if you are a first-generation college student.

Please provide the date of your final day of classes for spring 2015 session:

Transcript

Please attach an academic transcript in PDF format:

Awards, Honors, Extracurricular Activities

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

References

Please provide at least two references below (one reference should be from a faculty member. If you have research experience, please include a recommendation from a research supervisor).

Please note: Upon completion of this form, each reference listed will receive an email requesting a letter of recommendation.

Reference 1
Reference 2
Reference 3

Personal Statement

Please describe 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.


How did you learn about this research program? 

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

Student Signature:    Date: 04/28/2015