Exit this survey Graduate Application- IMSD 2020 Default Section IMSD Eligibility: The IMSD Program at UCSC offers support to qualified predoctoral students who have demonstrated and show promise for future achievement in biological and biomedical research or other related fields. Funded through NIGMS, NIH the purpose of the IMSD program is to encourage the development and increase the research competitiveness of students at the graduate level and to facilitate their progress toward a career in biomedical research and other related fields. One of the goals of IMSD is to create agents of change and leaders in STEM that will have a scientific and social impact in the their future careers.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) * One letter of recommendation from your PI and one from another professor. This can be addressed to Melissa Jurica, faculty director for the NIH-IMSD program.Note: All documents can be emailed to yuli@ucsc.edu, sent to the Mailstop: Attn: Yulianna Ortega, MCD Biology or dropped in person to our offices in JBE 135-139 or to the drop box outside of JBE 139. Question Title * 1. First Name Question Title * 2. MI Question Title * 3. Last Name Question Title * 4. Last 4 digits of SS# Question Title * 5. Permanent (Home) Address: Address City State Zip (Home) Phone# Question Title * 6. Current Address Address City State Zip (Current/Cell) Phone# Question Title * 7. Email UCSC Email : Alternative Email: Question Title * 8. Racial or Ethnic Background (Check all that apply) American Indian or Alaskan Native Asian/Non-filipino Filipino Black or African American Hispanic White or Caucasian Pacific Islander Other: I decline to state Question Title * 9. Gender: Question Title * 10. Date of Birth: Question Title * 11. City and State or Country of Birth: Question Title * 12. Are you a US Citizen?: Yes No Question Title * 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. Yes (If yes, send a copy of your resident card and social security card to our office) No Question Title * 14. EDUCATION Current Department and Degree Objective: Expected Date of Graduation: PI: Undergraduate School Attended: Undergraduate Major: Year Graduated: Overall UG GPA: Other Graduate Schools Attended (if Applicable) Other Graduate Degrees Received ( if Applicable) Question Title * 15. FAMILY BACKGROUND Didn't finish HS High School Some college 2yr College Grad 4yr College Grad Post Grad Degree Unknown Deceased Father: Father: Didn't finish HS Father: High School Father: Some college Father: 2yr College Grad Father: 4yr College Grad Father: Post Grad Degree Father: Unknown Father: Deceased Mother: Mother: Didn't finish HS Mother: High School Mother: Some college Mother: 2yr College Grad Mother: 4yr College Grad Mother: Post Grad Degree Mother: Unknown Mother: Deceased Question Title * 16. Fathers information Father Occupation Question Title * 17. Mothers information Mother Occupation Question Title * 18. Siblings How many siblings do you have? How many are in college? Question Title * 19. ESSAYS QUESTION #1Please type out your responses to the following questions. Please limit yourresponses 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. Question Title * 20. ESSAY QUESTION #2Discuss the reason why you would like to participate in a biomedical research training program committed to diversity and completion of the PhD Degree. Question Title * 21. ESSAY QUESTION #3What 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? Question Title * 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. Question Title * 23. CHECKLIST OF DOCUMENTS TO BE SUBMITTEDPlease submit documents in PDF format ( CV, Transcript, Residency verification) to yuli@ucsc.eduNote: Place your name and UCSC ID# in the e-mail subject heading. Unofficial Transcripts ( photocopies are OK of the most recent available online from the student portal) Your CV Two Letters of Recommendation: 1 from your PI and the other from another faculty member. Please send the letters to Yulianna Ortega STEM Diversity Director, Mailstop: MCD Biology or they may be emailed directly from faculty member to yuli@ucsc.edu Question Title * 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. I have read and understood the above passage and agree to the conditions stated above Question Title * 25. Please provide your electronic signature Question Title * 26. Date of application submission . Date Done