2022 EMSOP SURF Application Form

We are excited about your interest in the Summer Undergraduate Research Fellowship (SURF) Program. This is a full-time 10 week summer program. Applications must be submitted electronically by midnight on February 1, 2023.

Note: We will not be emailing your letter writters - you need to send them the weblink to upload themselves.
CONTACT INFORMATION
Full Name *

First Name Last Name
Permanent Address *

Street Address

Street Address Line 2

City State / Province

Country
Campus Address

Street Address

Street Address Line 2

City State / Province

Country
University E-mail Address *
Personal Email Address *
Do you have local housing for the entire 10-week SURF Program? *

Yes No
UNIVERSITY. Students must be enrolled at a U.S. university or college for the Fall 2023 semester as an undergraduate/professional student.
University/College *
Current Year *
Major *
Cumulative GPA *
Expected Graduation Date. Please enter as a two digit month and two digit year (example: 05/23). *
Year
Are you currently enrolled in the Rutgers PharmD Honors Program? *

Yes No
Are you currently enrolled in the Rutgers Honors College? *

Yes No
Do you have any previous research experience? If you answer yes, please answer the following questions: *

Yes No
How long have you participated in research?
Did you work on a laboratory or clinical project?

Laboratory Clinical
Where did you perform this research (name of institution)?
Who was your research mentor?
LETTER(S) OF RECOMMENDATION
Only 1 letter of recommendation is required. This letter must be from a professor or research advisor who is familiar with your work. If you have made arrangements to work with a specific research mentor, then they need to submit your letter of recommendation. List the name, position, phone number, and email address of each person that will provide a letter of recommendation.

YOU NEED TO SEND THE LINK FOR YOUR LETTER WRITERS TO UPLOAD THEIR LETTER by Feb 1st! We will not be emailing your letter writers to request their letter.

A second letter of recommendation can be included, but is not required.
Full Name *

First Name Last Name
Title or Position *
E-mail Address *
Full Name

First Name Last Name
Title or Position
Professional Email Address. Do not use gmail or personal email addresses for references.
SUMMER FELLOWSHIP
Have you previously applied to the SURF Program? *

Yes No
Have you previously participated in the SURF Program? *

Yes No
RESEARCH AREAS
SURF students perform their research in 6 different areas (Pharmacology and Toxicology, Environmental Health Sciences, Pharmaceutics, Chemical Biology, Pharmacy Practice, Medicinal Chemistry). Please select your top 2 choices of research areas. More information about these areas is available here.
What is your first choice? *
What is your second choice? *
RESEARCH MENTOR
Has a professor agreed to serve as your mentor for the SURF Program? As a reminder, you do not need to have a mentor at the time of application. Most applicants do not have one. *

Yes No
If yes, please indicate the professor's name.
CAREER GOALS
Which best describes your career goals? More than 1 option can be selected. *

Ph.D. degree M.D. degree Pharm.D. degree M.S. or M.P.H. degree Post-Graduate Fellowship Post-Graduate Residency
DEMOGRAPHIC INFORMATION
This information is used only for federal reporting to NIH and is not part of the application process. All demographic data is reported in aggregate. However, your participation is greatly appreciated to ensure continued funding.
To which gender identity do you identify?

Male Female Non-binary Gender variant/non-conforming Prefer not to disclose
Do you identify as Hispanic or Latino? *

Yes No Prefer not to disclose
Are you 18 years old or older? *

Yes No
Do you identify as any of the following racial categories (select all that apply)? *

American Indian/Alaska Native Asian Native Hawaiian/Other Pacific Islander Black or African American White Prefer not to disclose
Citizenship *

US Citizen Permanent Resident
Are you the first in your family to attend college (4 year degree)? *

Yes No Prefer not to disclose
Do you have a disability? *

Yes No Prefer not to disclose
Do you come from an economically or educationally disadvantaged background? This include eligibility for work study. *

Yes No Not sure Prefer not to disclose
EMERGENCY CONTACT INFORMATION
Full Name *

First Name Last Name
Relationship to Applicant
Phone Number *

Area Code Phone Number
RESUME/CV & PERSONAL STATEMENT
Please upload your application as a single pdf file that contains the three following components:
- Resume/CV
- Personal Statement (1 page limit single spaced)
- Unofficial Transcripts
Your personal statement should clearly explain why you are applying for this program. This is one of the most critical parts of the application review. In your personal statement, you should indicate:
- Your career plans after college including plans for graduate or post-graduate study (PhD degree, residency, fellowship, etc)
- What you hope to gain from this experience and how it will advance your career goals.
- Previous relevant work or research experience, honors, awards, or academic accomplishments or work-related characteristics
- The names of potential mentors/laboratories that you are looking to work with for SURF
- If you are requesting participation for a second summer, please describe specifically how you will benefit from a repeat experience.
Upload your application file containing your 1) CV/resume, 2) personal statement and 3) unofficial transcripts here. *
By signing this application, you agree that if you are awarded a position in SURF and accept it, you are committing 100% to this program and will withdraw all other summer program applications. Signature *
Date *

Month Day Year
Should be Empty:

CONTACT INFORMATION

UNIVERSITY. Students must be enrolled at a U.S. university or college for the Fall 2023 semester as an undergraduate/professional student.

LETTER(S) OF RECOMMENDATION

SUMMER FELLOWSHIP

RESEARCH AREAS

RESEARCH MENTOR

CAREER GOALS

DEMOGRAPHIC INFORMATION

EMERGENCY CONTACT INFORMATION

RESUME/CV & PERSONAL STATEMENT