Summer Research Program High School Application
Applications are due by 5:00 pm on March 1st. No late submissions will be accepted. Please direct all questions to SummerResearch@lsuhsc.edu; no phone calls, please.
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
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Place of Birth (City, State or Country)
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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
Not Hispanic
Choose not to respond
Gender
Please Select
Male
Female
Other
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
3. Academic Information
Only Juniors and Seniors at the time of application will be considered.
Current High School
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Current Level
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Junior
Senior
Overall GPA
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School planning to attend in Fall
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Reference #1 (Name)
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Reference #1 (Title)
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Reference #1 Phone Number
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Area Code
Phone Number
Reference #1 E-mail
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Reference #2 (Name)
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Reference #2 (Title)
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Reference #2 Phone Number
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Area Code
Phone Number
Reference #2 E-mail
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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.
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Behavioral & Community Health
Biochemistry
Bioinformatics
Biostatistics
Cancer Research
Cardiovascular Research
Cell Biology
Environmental Health
Epidemiology
Genetics
Health Disparities
Health Policy
Immunology
Microbiology
Molecular Biology
Neuroscience
Other
Preferred Faculty Mentors (if known)
Please list laboratory experience, previous internships, and/or lab rotations (if any)
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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