SUCRE

SUCRE

Summer Undergraduate Cancer Research Experience Application
Applications are due by 5:00pm on January 15, 2025. No late submissions will be accepted. Please direct all questions to contact@lcrc.info; no phone calls please.
Personal Information
Full Name*

First NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Place of Birth (City, State or Country)*
E-mail*
example@example.com
Alternate Email*
example@example.com
Home Phone Number*
Cell Phone Number*
Emergency Contact *

First NameLast Name
Emergency Contact Number *
Relationship to Emergency Contact*
Are you a US citizen?

YesNo
If you answered no, please indicate your status
Have you ever been employed as a student worker or participated in a summer program at LSU Health Sciences Center-New Orleands or LCRC?

YesNo
If you answered yes to the above question, please specify which summer program and year you participated. If you were employed as a student worker, please specify which Department and School at LSUHSC and provide specific dates of employment.
Demographics

LSUHSC is an equal opportunity/affirmative action employer. Our training programs are supported in part through funding from federal, regional, and local sources. The items below are useful to us in order to assess and report the diversity of applicants and participants in our program. Responses are voluntary and will in NO way influence assessment of your application.
Race: Please choose all that apply. If choosing other, please specify what race.

African American/BlackAlaskan NativAsianCaribbean/West IndianCaucasian/WhiteMiddle EasternNative American IndianNative Hawaiian/Pacific IslanderOtherChoose not to disclose
If you chose other, please specify:
Gender
Do you have a disability?
Are you from a disadvantaged background? (For example, are you first-generation to attend college?
Academic Information
School currently enrolled*
Current Level*

FreshmanSophomoreJuniorSenior
Overall GPA*
Major GPA*
School planning to attend in Fall*
Major*
Minor*
Reference #1 (Name)*
Reference #1 (Title)*
Reference #1 Phone number*
Please enter a valid phone number.
Reference #1 e-mail*
example@example.com
Reference #2 (Name)*
Reference #2 (Title)*
Reference #2 Phone number*
Please enter a valid phone number.
Reference #2 e-mail*
example@example.com
Research Information
Preferred Faculty Mentors (If known)
Please list laboratory experience, previous internships, and/or lab rotations (if any)
Do you object to doing animal research?*

YesNo
Plans for Future Education

The items below are useful for us to assess the current career interest of applicants and participants in our program.
After you complete your bachelor's degree, do you plan to pursue further educaiton?*
Which type9s) of further education are you considering or planning to pursue? (mark one or more)*

Graduate School (e.g. MA, MS, PhD, MD/PhD)Professional training in Medicine, Nursing, or Pharmacy (e.g. MD, DO, PA, RN, PharmD)Professional training in Public Health (e.g. MS, MPH, PhD, MD/MPH)Professional training in Allied Health (e.g. Physical Therapy)Professional degree: Dental (e.g. DDS)Professional degree: Veterinary (e.g. DVM)Professional degree: Law (e.g. JD)Not SureOther
If known, what school do you plan to attend following graduation?
Leave blank if unknown or not applicable
Scientific Background and Skills Assessment

Research experience is NOT required for admission to the program, but we need accurate information in order to assess your previous experience and match selected participants to the most appropriate projects.
Please select all those that apply to your expeience
Required Attachments
Please attach a cover letter describing your research interest and career goals (PDF, DOC, or DOCX format only).*

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Please attach a resume describing schools attended, previous job experience, and relevant accomplishments (PDF, DOC, or DOCX format only).*

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