Summer Research Program Application

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.
**DUE TO THE COVID-19, THE START DATE, PROGRAM EXPECTATIONS AND OTHER ELEMENTS OF THE PROGRAM ARE SUBJECT TO CHANGE.
1. Personal Information
First Name*
Middle Name
Last Name*
Current Address*
City*
State*
Zip Code*
Date of Birth *

MonthDay Year
Place of Birth (City, State or Country)*
E-mail Address*
Alternate E-mail*
Home Phone Number

Area Code Phone Number
Cell Phone Number*

Area Code Phone Number
Emergency Contact*

First Name Last Name
Emergency Contact Phone Number*

Area Code Phone Number
Relationship to Emergency Contact*
Are you a US citizen?*

YesNo
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?*

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.
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/BlackAlaskan NativeAsianCaribbean/West IndianCaucasian/WhiteMiddle EasternNative American IndianNative Hawaiian/Pacific Islander
Ethnicity
Gender
Do you have a disability?
3. Academic Information

Only Juniors and Seniors at the time of application will be considered.
Current High School*
Current Level*

JuniorSenior
Overall GPA*
School planning to attend in Fall*
Reference #1 (Name)*
Reference #1 (Title)*
Reference #1 Phone Number*

Area Code Phone Number
Reference #1 E-mail*
Reference #2 (Name)*
Reference #2 (Title)*
Reference #2 Phone Number*

Area Code Phone Number
Reference #2 E-mail*
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.*

Behavioral & Community HealthBiochemistryBioinformaticsBiostatisticsCancer ResearchCardiovascular ResearchCell BiologyEnvironmental & Occupational HealthEpidemiologyGeneticsHealth DisparitiesHealth PolicyImmunologyMicrobiologyMolecular BiologyNeuroscience
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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Summer Research Program High School Application

1. Personal Information

2. Demographics

3. Academic Information

4. Research Interest Information