IMSD Graduate Research Program Application 2012
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1. Default Section

 
In order to consider your application complete please be sure to include all of the following:
* Completed online Application (this includes essay questions)
* Your CV
* Copy of Your Unofficial Transcripts (just print them from your student portal)
* Two letters of recommendation preferably from faculty (These letters must be sent directly to the Program Staff Director or included in your packet in a sealed and signed envelope to ensure that the applicant does not view the letter.  Faculty may send the letters to:  Malika Bell, STEM Diversity Director.  Mailstop: MCD Biology or they may be emailed directly from faculty member to malika@ucsc.edu).

Note: All documents can be sent to malika@biology, dropped in person to our offices Thimann 375 and 371 or left in our drop box outside of Thimann 377.

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1. First Name

2. MI

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3. Last Name

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4. Last 4 digits of SS#

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5. Permanent (Home) Address:

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6. Current Address

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7. Email

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8. Racial or Ethnic Background (Check all that apply)

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9. Gender:

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10. Date of Birth:

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11. City and State or Country of Birth:

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12. Are you a US Citizen?:

13. If no, are you a Permanent Resident:
*Our programs are funded by US government so we cannot financially support students who do not either have US citizenship or a permanent resident card. If you have an F1 or other Visa or you are not living legally in the US and you would still like support we still may have other ways to support you. Please contact the staff director.

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14. EDUCATION

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15. FAMILY BACKGROUND

 Didn't finish HSHigh SchoolSome college2yr College Grad4yr College GradPost Grad DegreeUnknownDeceased
Father:
Mother:

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16. Fathers information

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17. Mothers information

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18. Siblings

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19. ESSAYS QUESTION #1

Please type out your responses to the following questions. Please limit your
responses to 200 words for each question.

Please describe your personal background and what experience led you to where you are today in your education? Do not hesitate to express relevant extra curricular activities, and any interesting or unusual circumstances or obstacles in your personal or academic background.

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20. ESSAY QUESTION #2
Discuss the reason why you would like to participate in research training program committed to diversity and completion of the PhD Degree.

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21. ESSAY QUESTION #3
What are your long-range career aspirations after you obtain your Ph.D.? What career do you see yourself taking on? If you are unclear about a specific career, please share a number of possibilities you foresee for you in the future. How do you plan to reach these goals?

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22. ESSAY QUESTION #4
Describe your current work in lab. What short-term goals do you have for your project? Make a rough time-line of your planned project progression for the next year or two.

23. CHECKLIST OF DOCUMENTS TO BE SUBMITTED
Please submit documents in PDF format ( CV, Transcript, Residency verification)
Note: Place your name and UCSC ID# in the e-mail subject heading.

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24. Certification
I certify that the information reported on this application, to the best of my knowledge, is true and correct. I authorize IMSD staff and faculty to review my application in its entirety. If I am selected as a participant, I authorize UC Santa Cruz to publicize any relevant scholarship and biographical information and/or publish photographs. I also agree to participate in the assessment of IMSD program by completing surveys and participating in focus groups and/or interviews regarding my perceptions and personal experiences in the program. I understand that all information will be treated as confidential by the researcher.

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25. Please provide your electronic signature

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26. Date of application submission

 MM DD YYYY 
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