Graduate School of Biomedical Sciences

Online Application for SURP

To complete the application process, please provide an unofficial transcript from your undergraduate institution(s) and two letters of recommendation, one from a faculty member and one from your advisor. Please scan through the application before starting and make sure that you have all the necessary information available. Please type in N/A for fields that do not apply to you. After filling out the form, please click submit. You should get a confirmation page.
All information provided is stored in a secure server. All fields marked with an * must be filled in. Applications will not be considered unless all materials are received by the deadline of February 15, 2012.

Personal Information


First Name *
Middle Name/Initial
Last Name *

Current Address


Street *
Apartment
City *
State *
Zip Code *
Current Address Until (mm/yyyy)
Day Phone Number *
Evening Phone Number *
Personal Email *

Permanent Address


Street *
Apartment
City *
State *
Zip Code *
Home Phone Number

Supplemental Information


Gender *
Date of Birth *	Month/Day/Year (mm/dd/yyyy)
Ethnicity
Have you participated in these programs?
Are you related to any one enrolled or working at UTMB?
Who referred you to UTMB?

Supplemental information on the applicant, other than Gender and Date of Birth, is not required, and if provided, will not be considered in the admission decision. This will only be used for completing required state and federal statistical reports. UTMB is subject to federal regulations concerning equal opportunity and affirmative action. UTMB does not discriminate against applicants or students on the basis of race, color, national origin, religion, sex, age, disability, sexual orientation, or status as a Vietnam veteran. Reasonable accommodation, based on disability or religious observances, will be considered when appropriate.

Citizenship and Residence Status


Are you a US Citizen? *
If you are not a US citizen, please specify Visa Type
Are you a Texas Resident? *

Education : Current Institution


Institution Name *
Location *
Dates Attended: From *	Month/Year (mm/yyyy)
Dates Attended: To *	Month/Year (mm/yyyy)
Major *
Minor
GPA *
Math/Science GPA
List of Math and Science Coursework
Expected Graduation Date *	Month/Year (mm/yyyy)
Year in School *

Education : Previous Institution


Institution Name
Location
Dates Attended: From	Month/Year (mm/yyyy)
Dates Attended: To	Month/Year (mm/yyyy)
Major
Minor
GPA

References (Name a faculty member and the advisor who you asked to provide a letter of recommendation)


Faculty Name *
Advisor Name *

Please have the letters mailed to: The Graduate School of Biomedical Sciences Attn: SURP The University of Texas Medical Branch 301 University Blvd. Galveston, TX 77555-1050

Career Goals (If you consider a PhD, MD, or MD/PhD degree, please answer the followig questions)


Career Goals *

If you consider a Ph.D. degree (skip if not applicable):

Would you consider a Graduate School in Texas?	Yes No
Would you consider the Graduate School of Biomedical Science of UTMB in Galveston?	Yes No

If you consider an M.D. degree (skip if not applicable):

Would you consider a Medical School in Texas?	Yes No
Would you consider the Medical School of UTMB in Galveston?	Yes No

If you consider a M.D./Ph.D. degree (skip if not applicable):

Would you consider a M.D./Ph.D. Program in Texas?	Yes No
Would you consider a M.D./Ph.D. Program of UTMB in Galveston?	Yes No

Supporting Academic Information


Please describe what you hope to gain through your participation in the UTMB Summer Undergraduate Research Program. (No longer than 2000 characters): *



Please describe what you consider the most significant scientific advance you have read or heard about in the last year. (No longer than 1000 characters): *



If a GRE course is offered during the summer, will you take it?	Yes No

Will you pay the $25.00 registration fee to hold a place for the GRE course?	Yes No

Are you interested in computer modeling?	Yes No

Do you have an engineering, physical science or inorganic chemistry background/major?	Yes No

Do you have a computer science background?	Yes No

Would you prefer a data analysis experience?	Yes No

Would you prefer a bench science experience?	Yes No

Would you work in a lab that uses animals or animal products?	Yes No

Would you prefer an experience that generates data from interviews?	Yes No

Research Profile and Areas of Interest:


Have you had previous research experience?	Yes No
Topic and Length of Experience

Please rank the top five research topics that interest you in order of preference, with the first being the topic of highest interest (i.e. a topic that you would like to be involved in during the summer).

Topic of 1st Choice *

Topic of 2nd Choice *

Topic of 3rd Choice *

Topic of 4th Choice *

Topic of 5th Choice *

Other, If any