Summer Research Program Undergraduate 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
Other
Ethnicity
Please Select
Hispanic, Latino or Spanish origin
Not Hispanic, Latino or Spanish origin
Gender
Please Select
Male
Female
Other
Do you have a disability?
Yes
No
Are you from a disadvantaged background? (For example, are you first-generation to attend college?)
Yes
No
3. Academic Information
School currently enrolled
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Current Level
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Freshman
Sophomore
Junior
Senior
Overall GPA
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Major GPA
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School planning to attend in Fall
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Major
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Minor
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
Covid-19
Environmental & Occupational 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)
Do you object to doing animal research?
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Yes
No
5. 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 education?
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Yes - definitely
Maybe - I'm considering it
No - I do not plan to pursue further education
I don't know - I haven't thought about it
Which type(s) of further education are you considering or planning to pursue? (mark one or more)
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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 sure
Other
If known, what school do you plan to attend following graduation?
Leave blank if unknown or not applicable
6. 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
7. 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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