Summer Research Program Medical Student Application
Applications are due by 5:00 pm on February 1st. Please direct all questions to SummerResearch@lsuhsc.edu
1. Personal Information
First Name
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Middle Name
Last Name
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Current Address
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City
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State
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Zip Code
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Date of Birth
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Month
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Day
Year
E-mail Address
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Alternate E-mail
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Home Phone Number
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Area Code
Phone Number
Cell Phone Number
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Area Code
Phone Number
Emergency Contact
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First Name
Last Name
Emergency Contact Phone Number
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Area Code
Phone Number
Relationship to Emergency Contact
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Are you a US citizen?
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Yes
No
If you answered no, please indicate status
Please Select
Permanent Resident
Student Visa
Foreign National
Have you ever been employed as a student worker or participated in a summer program at LSU Health Sciences Center-New Orleans?
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Yes
No
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
2. 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/Black
Alaskan Native
Asian
Caribbean/West Indian
Caucasian/White
Middle Eastern
Native American Indian
Native Hawaiian/Pacific Islander
Choose not to respond
Other
Ethnicity
Please Select
Hispanic, Latino or Spanish origin
Not Hispanic, Latino or Spanish origin
Choose not to respond
Gender
Please Select
Male
Female
Other
Choose not to respond
LSUHSC-New Orleans is committed to creating an inclusive and accessible environment according to the ADA, ADAA, and Section504 of the Rehabilitation Act of 1973. Do you need accommodations?
Yes
No
Are you from a disadvantaged background? (For example, are you first-generation to attend college?)
Yes
No
3. Academic Information
What school are you currently attending?
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LSUHSC
Other
Name of undergraduate institution
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Degree awarded
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Overall GPA
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Major
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Minor
Other Degrees (Degree Received/Institution)
Are you an MD/PhD student?
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Yes
No
4. Research Interest Information
Please check the areas of research that you are interested in. You may list specific faculty labs if you have identified such. Listing specific labs does not guarantee placement.
Biochemistry
Bioinformatics
Cardiology
COVID-19
Diabetes/ Obesity
ENT
Epidemiology
Gastroenterology
Genetics
Health Disparities
Hematology
Immunology
Microbiology
Molecular Biology
Nephrology
Neurology
Neuroscience
Neurosurgery
OB/GYN
Orthopaedics
Pediatrics
Pharmacology
Physiology
Pulmonology
Surgery
Other
Preferred Faculty Mentors (if known)
Please list laboratory experience, previous internships, and/or lab rotations (if any)?
Do you object to doing animal research?
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Yes
No
If selected, are you willing/able to intern in Baton Rouge, LA (housing not provided)?
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Yes
No
5. 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 experience.
6. Required Attachments
Please attach a cover letter describing your research interests 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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