Summer Research Program Application

Summer Research Program Medical Student Application

Applications are due by 5:00 pm on Tuesday, January 20th. Please direct all questions to SummerResearch@lsuhsc.edu
1. Personal Information
First Name
Middle Name
Last Name
Current Address
City
State
Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
E-mail Address
Alternate E-mail
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Emergency Contact

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
Relationship to Emergency Contact
Are you a US citizen?
If you answered no, please indicate status
Have you ever been employed as a student worker or participated in a summer program at LSU Health Sciences Center-New Orleans?
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.

Other
Ethnicity
Gender
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?
Are you from a disadvantaged background? (For example, are you first-generation to attend college?)
3. Academic Information
What school are you currently attending?

Other
Name of undergraduate institution
Degree awarded
Overall GPA
Major
Minor
Other Degrees (Degree Received/Institution)
Are you an MD/PhD student?
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.
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?
If selected, are you willing/able to intern in Baton Rouge, LA (housing not provided)?
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 (Label as "Last Name Cover Letter". Submit in a PDF format only).

Browse Files

Cancelof
Please attach a resume describing schools attended, previous job experience, and relevant accomplishments (Label as "Last Name Resume". Submit in a PDF format only).

Browse Files

Cancelof
Please attach a copy of your unofficial transcript (Label as "Last Name Unofficial Transcript". Submit in a PDF format only).

Browse Files

Cancelof
Should be Empty:

Summer Research Program Medical Student Application

1. Personal Information

2. Demographics

3. Academic Information

4. Research Interest Information

5. Scientific Background and Skills Assessment

6. Required Attachments