Name:
First: Last:
Your College or
University:
Class:
Freshman
Sophomore
Junior
Senior
Postbac
Not a student
When do you plan to
graduate?
Spring 2013
Summer 2013
Fall 2013
Winter 2014
Spring 2014
Summer 2014
Fall 2014
Winter 2015
Spring 2015
Summer 2015
Fall 2015
Winter 2016
Spring 2016
Summer 2016
Fall 2016
Later
What is your major?
If you transferred from
another institution, please list:
E-mail Address:
Phone Numbers:
Cell:
Other: (if
preferred)
Current Address :
Street: City:
State:
Zip Code:
Permanent Address :
Street: City:
State: Zip
Code:
Home phone:
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:
African American
Alaska Native
Asian
Hispanic
Native American
Pacific Islander
White
Multiracial
Other
Decline response
If "Multiracial or Other",
please explain
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 this program?
Internet search
ABRCMS meeting
SACNAS meeting
College advisor
Mailing or poster
Other
Have you
participated previously in a summer undergraduate research
program at another institution? If so, list name of
Program & Institution. If not, check No
Yes
No Institution/Program Name
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
Do you plan to take the
GRE, MCAT or other graduate/professional
school admissions standardized exam? If so, when?
No
GRE
MCAT
DAT
VCAT
LSAT
GMAT
Other
Date:
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:
1st Choice:
Biochemistry
Bioinformatics
Biology
Biophysics
Cell Biology
Chemistry
Cognitive
Neuroscience
Computer
Science
Genetics
Developmental
Biology
Ecology
Environmental
Studies/Sciences
Evolutionary
Biology
Exercise
General Science
Human Biology
Human Physiology
Marine Biology
Mathematics
Microbiology
Molecular Biology
Neurobiology
Physics
Physiology
Psychology
Structural Biology
Other
Importance:
High
Medium
Low
2nd Choice :
Biochemistry
Bioinformatics
Biology
Biophysics
Cell Biology
Chemistry
Cognitive
Neuroscience
Computer
Science
Genetics
Developmental
Biology
Ecology
Environmental
Studies/Sciences
Evolutionary
Biology
Exercise
General Science
Human Biology
Human Physiology
Marine Biology
Mathematics
Microbiology
Molecular Biology
Neurobiology
Physics
Physiology
Psychology
Structural Biology
Other
Importance:
High
Medium
Low
3rd Choice:
Biochemistry
Bioinformatics
Biology
Biophysics
Cell Biology
Chemistry
Cognitive
Neuroscience
Computer
Science
Genetics
Developmental
Biology
Ecology
Environmental
Studies/Sciences
Evolutionary
Biology
Exercise
General Science
Human Biology
Human Physiology
Marine Biology
Mathematics
Microbiology
Molecular Biology
Neurobiology
Physics
Physiology
Psychology
Structural Biology
Other
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 SPUR
link describing participating laboratories, please list
a few laboratories for which you might have a preference
(if any) .
F: Describe your outside interests and activities:
(optional)
G: Paste or type your classes and grades here -- ( as
neatly as possible;
no official transcripts or images;
please include courses you're
currently taking )
H: Please arrange for two letters of
reference from faculty at your home institution to be
sent by email (preferred)
to spur@uoregon.edu
Who
will submit recommendation letters for you? (see
"Letters of Recommendation", below)
Faculty reference 1
Name; Department; Institution:
email:
Faculty reference 2
Name; Department; Institution:
email: