Personal Information
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Last 4 digits of Social Security Number (such as 3333):
Date of Birth: (MM/DD/YYYY)
Gender: |
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: |
| Race/Ethnicity: |
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Current Address Information
(Your school address and contact information) |
Address Line 1:
Address Line 2:
City:
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:
City:
State/Country: Zip Code:
Permanent Telephone #:
Other Email: |
Education Information |
| High School Name & Date of Graduation: |
| City & State: |
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| Undergraduate Institution: |
| Year In School Major: |
| GPA (Total): & GPA (In Major): |
List any honors, fellowships or special awards (e.g. MARC Scholar, NSF
or Howard Hughes Fellow, College or University recognition of achievement:
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| I am a first generation college student. |
My family has an annual income below established low-income thresholds.
For guidelines visit this site:
http://aspe.hhs.gov/poverty/index.shtml
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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: |
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| 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. |
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Indicate your areas of research interest in order of
preference from the three lists below: |
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Area of Interest Preference indicate #1 #2 & #3
Biodefense
Biomathematics
Biophysics
Cancer
Cardiovascular Biology and Disease
Cell Adhesion
Cell Secretion
Cell Signaling
Cellular Growth/Regulation
Computer Modeling
Cytokines/Growth Factors
Cytoskeleton
Diabetes
Developmental Biology
Endocrinology
Enzymology
Extracellular Matrix
Gene Expression
Gamete Interaction
Gene Regulation
Hypertension/Renal Disease
Immunology
Infectious Diseases
Intracellular Trafficking
Membrane Transport
Metabolism
Molecular Genetics
Molecular Pharmacology
Morphogenesis and Differentiation
Neurodegenerative Disease
Neuroendocrinology
Neuroscience
Oncogenes
Parasitology
Protein Structure and Function
Receptor Biology
Reproductive Biology
Signal Transduction
Vaccine Development
Virology
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Parts A-D |
A) 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.
(paragraph box for your text here) |
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There will be a button here on the application (click it only once, please!) which will submit your information and then take you to a page that provides instructions on how to submit SRIP Application Parts B-D.
B) Personal Statement
C) Official Transcript
D) Letters of Reference
To view the B-C-D Page click here:
http://www.healthsystem.virginia.edu/internet/gpo/srip/applic_bcd.cfm
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This is an example application.
You must use the on-line form to apply to the program.
PAPER OR FAXED APPLICATIONS WILL NOT BE ACCEPTED
If you are ready to provide all of this information now, please proceed to the on-line application
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