SURIP- HS Internship Application

Center for Health Disparities Research & Education High School Summer Internship Program 2009

STUDENT APPLICATION INSTRUCTIONS

A. ELIGIBILITY CRITERIA

Students must be enrolled in high school or incoming freshman in college
Candidates must be U.S. citizens or permanent residents
Students who are interested in the biomedical sciences and healthcare fields

INSTRUCTIONS ON HOW TO APPLY

PLEASE REVIEW ALL INSTRUCTIONS NOTED BELOW. THIS WILL ENSURE THAT YOUR APPLICATION IS COMPLETE, INCOMPLETE APPLICATIONS WILL NOT BE REVIEWED.

USU Center for Health Disparities
Summer High School Internship Program
4301 Jones Bridge Road. - Bldg. 28
Bethesda, Maryland 20814

Interested applicants must complete and submit the following:

1. Application
2. Personal Statement
3. Letters of Recommendation MUST be accompanied by the recommendation form
4. Official Transcript must be in a sealed envelope with registrar's official stamp
5. Résumé (Optional)

The deadline for receipt of completed applications is May 1, 2009 (11:59 p.m., Eastern Standard Time). Applications that are incomplete after the May 1 deadline will not receive further consideration.

Proofread your application thoroughly for accuracy and completeness; false or inaccurate information may be grounds for denying your candidacy or removing you from the program.

Be sure that the e-mail addresses you provide are accurate. Incorrect e-mail addresses will delay the processing of your application and could result in your application not receiving full consideration.

All supporting application materials (e.g., recommendation letters and official transcripts) should be sent together in ONE Application Packet to the address below.

1. Recommendation letters should be submitted with the recommendation form in a sealed envelope, with your recommender's signature over the flap before placing them in the Application Packet.
2. The official transcript should also be placed in a sealed envelope before placing them in the Application Packet.

Incomplete applications will NOT be reviewed.

USU Center for Health Disparities
Summer Graduate Research Internship Program
4301 Jones Bridge Road. - Bldg. 28
Bethesda, Maryland 20814

After you have completed your application and your supporting materials packet has arrived, you will receive a message that your application is complete. You are welcome to send an email to USUCHDinternship@usuhs.mil to request your application status. Applications will not be considered complete until the application and all supporting documentation is received.

B. APPLICANT INFORMATION
Applicant's Name:	Last:
	First:
	Middle:
	Birth date:

Permanent Address:	Street:
	City:
	State:
	Zip:

Telephone: (Area Code/Number)
Email Address:

C. CITIZENSHIP STATUS
		United States Citizen
		Other
If Other, specify:

D. RACE/ETHNICITY (Please check one)
		African American or Black
		American Indian or Alaska Native
		Native Hawaiian or other Pacific Islander
		Hispanic or Latino
		White
		Other
If Other, specify:

E. ACADEMIC INFORMATION
School Mailing Address:
Name of High School:
	Street:
	City:
	State:
	Zip:
School Telephone: (Area Code/Number)

Next Year's Grade Level:
Current Cumulative GPA: (or letter grade average)

G. PREVIOUS INTERSHIP EXPERIENCE Please list all relevant internship experience
1.	Organization
Date
Program Name
Supervisor/Mentor's Name
Telephone

2.	Organization
Date
Program Name
Supervisor/Mentor's Name
Telephone

3.	Organization
Date
Program Name
Supervisor/Mentor's Name
Telephone

4.	Organization
Date
Program Name
Supervisor/Mentor's Name
Telephone

5.	Organization
Date
Program Name
Supervisor/Mentor's Name
Telephone

H. PREVIOUS WORK HISTORY
1.	Organization
FROM (Start Date)
TO (Start Date)
Address
Telephone (Area Code/Number)
Supervisor's Name

2.	Organization
FROM (Start Date)
TO (Start Date)
Address
Telephone (Area Code/Number)
Supervisor's Name

3.	Organization
FROM (Start Date)
TO (Start Date)
Address
Telephone (Area Code/Number)
Supervisor's Name

I. CAREER INTERESTS
List Career Interests

J. REFERENCES
Please have 2-3 letters of recommendation with the recommendation form. Sent directly from your recommenders to the address listed above. The recommendation forms can be downloaded from the website. List recommenders below. A letter of recommendation will be expected from:
1. Recommender- Last
First
Title
Telephone (Area Code and Number)
Institution/Department
E-mail Address

2. Recommender- Last
First
Title
Telephone (Area Code and Number)
Institution/Department
E-mail Address

3. Recommender- Last
First
Title
Telephone (Area Code and Number)
Institution/Department
E-mail Address


K. PERSONAL STATEMENT
Cut and paste your personal statement into the space provided below. Please state your purpose in applying to the USUCHD High School Internship Program. Use 12 point Times New Roman font, double-spaced, with one-inch margins, no more than 2 pages. Relevant factors include but are not limited to the following: Please write an essay that describes the following: 1. Your career interests 2. Why you would like to participate in our summer program? 3. Any experiences or accomplishments that you would like us to know about


J. PRIVACY ACT STATEMENT
The information solicited in all Uniformed Services University of the Health Sciences Center for Health Disparities application materials is governed by the privacy act. I certify that the information submitted in this application form is complete and correct to the best of my knowledge and that the thoughts and words provided are mine. They have not been prepared or substantially modified by others. I understand that any misrepresentation may result in denial of admission.