Delaware Center for Neuroscience Research
Summer Undergraduate Research Program

Application - 2018 Program

(You may find it helpful to view or print out this Cheat-Sheet_Application - use this link)




Your permanent address (street, city, state, zip)

Your local address if different (street, city, state, zip)


Gender:


Are you a U.S. Citizen?


Ethnic Identity (optional):










Will you require housing at DSU for the summer?

No


Do you have a car (and need a parking permit?)

No


Name and address of institution attended:



Class:



Ultimate level of degree desired:



Academic Awards & Honors (briefly describe the honor or award and include the date received)
(text box can be resized via handle @ bottom right corner - PLEASE LIMIT TO 400 WORDS)

Activities, Accomplishments, and Career-Related Experiences (Briefly describe the activity, accomplishment, or experience and give the date it occurred)
(text box can be resized via handle @ bottom right corner - PLEASE LIMIT TO 400 WORDS)

Two references recommending your acceptance into this program are required. These individuals should be professionals in a science field.

Recommender #1: (Please include name-first and last, professional title & department, institutional affiliation, institution city & state, phone number, and email address)  (text box can be resized via handle @ bottom right corner)

Recommender #2: (Please include name-first and last, professional title & department, institutional affiliation, institution city & state, phone number, and email address)   (text box can be resized via handle @ bottom right corner)

Emergency Contact:



Please provide following information about your emergency contact: Name-first & last; address-street, city, state, zip; and phones-cell, work, home
(text box can be resized via handle @ bottom right corner)

If selected for the program, I would prefer to work in a lab at:



Using the file attachments button, please attach (1) a PDF copy of your transcript, and (2) a personal statement of no more than two pages describing your experience, interest, and career goals related to neuroscience and research. Most types of text documents including PDF, Word, text, RTF, and more can be uploaded.

If you already know the Delaware neuroscientist with whom you would like to work, please discuss that in your statement.

File attachments:

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