University of Virginia
Summer Research Internship Program (SRIP) 2010
On-line Application

Personal Information
Last 4 digits of your United States Social Security Number
(like "3333"): (if you don't have one-leave it blank)
Year of Birth:(YYYY)
Last Name(s)
First, Middle Name(s)
Are you a U.S. Citizen?:
If no, are you a permanent resident of the U.S.?
If you are not a Permanent Resident or U.S. Citizen, please enter your current visa type here:

Current Address Information
(Your school address and contact information)
Address Line 1:
Address Line 2:
State/Country: Zip Code:
Current Telephone #:
Current Email:
This address information will be current until what date?

Permanent Address Information
(Address of parent, relative or other permanent address at which you can always be contacted)
Address Line 1:
Address Line 2:
State/Country: Zip Code:
Permanent Telephone #:
Other Email:

Education Information
High School Name: Date of Graduation:
City: State:
Undergraduate Institution:
Year In School Major:
GPA (Total): GPA (In Major):

Are you currently supported by a Minority Access to Research Careers (MARC) Fellowship? 

If Yes, please provide the start and end dates of your award (DD/MM/YYYY):
Do you anticipate being supported by a MARC Fellowship prior to September 2010?  

List any honors, fellowships or special awards you have received (e.g. MARC Scholar,
NSF or Howard Hughes Fellow, College or University recognition of achievement):

Please provide us with the full names of the people who will be providing
recommendations for you:
Recommendation 1:
Recommendation 2:
Recommendation 3:
Recommendation 4:

I am a first generation college student.
My family has an annual income below established low-income thresholds.

I have received one of the following loans or scholarships
(Respond to all that apply):
Health Professional Student Loans (HPSL)
Loans for Disadvantaged Student Program
Scholarship for Individuals with Exceptional Financial Need
Federal Disadvantaged Assistance
You may provide us with information on other types of loans or aid that you have received in the field below:
I am an individual who has a physical or mental impairment that substantially limits one or more major life activities.

You may submit an optional statement that further describes your financial, historical, physical, mental circumstances or limitations.
Indicate your areas of research interest in order of
preference from the three lists below:

Area of Interest Preference #1

Area of Interest Preference #2

Area of Interest Preference #3


Past Research Experience and Long Term Goals (250 Maximum)
Compose a paragraph detailing any past experience in a research laboratory, even that associated with a class. This is your opportunity to explain your educational aspirations and why you want to participate in SRIP. Some questions you might consider are: What are your academic and/or career goals? How have your past experiences and background influenced your goals? How will SRIP help you achieve your goals? What do you expect to gain from an SRIP experience?

Statement of Research Interest (125 words maximum)
In order to identify potential faculty mentors for you, the SRIP reviewers need to know what areas of research interest you.  Please describe the area(s) that you would like to explore and why this research appeals to you.  If familiar with research conducted at UVA, please list the faculty, departments, programs and/or research centers, with whom you would be interested in executing a summer project.  

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