Summer Undergraduate Research Program Application

This form contains essay questions.
We suggest you complete those in a word processor first and then copy & paste them into the form. Please limit your essays to 100 words each.
Submission of this form is final.

Contact: MUSC SURP
Deadline: January 31, 2016 (no exceptions)

* = required

First Name *   MI Last Name *
Date of birth * (mm/dd/yyyy) Sex * Disabled *
School Mailing Address
Address *
City *
State *
Zip *
Permanent Mailing Address
Address *
City *
State *
Zip *
Phone * Alternate Phone
Email * Alternate Email (cannot be a school e-mail)*
Citizenship *
If not a US Citizen, of which country are you a citizen? *
If you have a permanent resident alien "green" card, please provide the number on the card: *
Ethnicity Are you Hispanic (or Latino)? *
What is your racial background? *
Disadvantaged Minority? *
Social Media Use Do you use Facebook? *
Do you use Linked-In? *
References Please request references from two individuals familiar with your work in a laboratory setting (faculty members, mentors, etc...). If this is your first laboratory experience, request the references from two faculty members. Provide the names, titles and departments of the faculty members from whom you are requesting references in the space below. *
Educational Background Beginning with the institution you are currently attending, please list the colleges/universities/high school you have attended. *
Name & location of school Major Expected Degree Graduation Date Overall GPA
Availability and housing Are you able to work starting May 30 continuously through August 5, 2016? *
Please indicate your housing arrangements should you be accepted: *
Research interests Please select your top four research interests:
1) *
2) *
3) *
4) *


Why are you applying to the MUSC Summer Undergraduate Research Program? (Limit 100 words) *

What are your career goals? (Limit 100 words) *

How will this experience help you meet these goals? (Limit 100 words) *

Describe any past experiences that have led you to your interest in research and in specific areas of research offered at MUSC. (Limit: 100 words) *