Immunology

Summer Immunology and Virology Undergraduate Fellowship - 2009

PERSONAL INFORMATION

Name (Last, First, M.I.):

Gender:

Male Female

Permanent Address:

Daytime telephone:

Evening telephone:

E-mail address:

Current Address:

Daytime telephone:

Evening telephone:

ACADEMIC HISTORY

Name & location of college/university currently attending:

Name & location of college/university previously attended:

Major:

Grade Point Average:

Date (or expected date) of conferral of degree:

List 2 faculty members from whom you have requested a letter of recommendation. The letters should come from faculty who know your academic/research work. Please include a complete mailing address and telephone.

Honors and awards:

GENERAL INFORMATION

Have you participated in a research program, or had any research experience?

Yes No

If yes, name of institution:

Name of investigator with whom you worked:

Area of work experience:

Year:

Length of research experience:

Other related work experience:

Dates you are available for the summer undergraduate fellowship (From-To):

Do you need housing?

Yes No

STATEMENT OF GOALS

Please include below a Statement Of Goals, or mail a typed, double-spaced document, stating your research interests, experience, education goals, career objectives and any information which may aid the selection process.

My future goals include the pursuit of:
Ph.D. :
M.D. :
M.D./Ph.D. :
R.N. :
Other:

Immunology and Virology Areas of Interest:

To help us place you in an appropriate laboratory, please indicate topics that are of major interest to you with a "1". Use "2" to indicate secondary interest. Please indicate several areas of interest. Although we will try and match your interests, all labs may not be able to accommodate a student fellow.

T cells	cell-cell interactions
B cells	homeostasis
cancer	development
infectious diseases	gene regulation
HIV disease	recombination
inflammatory bowel disease	structure
autoimmunity	signal transduction
inflammation	innate immunity

List several TSRI Immunology and Microbial Sciences Labs whose research sounds interesting to you.

Immunology

Summer Immunology and Virology Undergraduate Fellowship - 2009

STATEMENT OF GOALS

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