Summer Student Research Academy Application Summer 2009 Beckman Research Institute City of Hope 2009 registration is closed First name:      Last name:    Home/Parent Address:    City:    State:  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:     Check if School term address below is the same as above:   School Address:             City:    State:  AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:    Home Phone: (  )         School Phone: (  )        Cell Phone: ( )    Email Address:      Confirm Email Address: School:                 Major (if applicable):  Academic Level:  High School Freshman High School Sophomore High School Junior High School Senior College/University Freshman College/University Sophomore College/University Junior College/University Senior Other            Specify Other:         Gender (optional): MaleFemale                                 Ethnicity (optional):  African American Asian Caucasian Hispanic Native American Indian Pacific Islander Other Do you have a family member currently working at COH? YesNo If Yes, name of family member - First name:   Last name:                                        COH Department:   Do you wish to apply for the Cure Student Program? If so, please specify your Ethnicity.  Please answer these questions to help us estimate your potential for a meaningful summer research experience. Be specific and brief in your answers (no more than 250 characters per box). Prior research experience is not a requirement for acceptance into our program. Why are you interested in a summer research opportunity?: Why are you a good candidate for our program?: What area(s) of research are most interesting to you?: If possible, list 2 or 3 laboratories you would like to work in: What is your career goal?: What relevant course work have you completed or have in progress?: Do you have any previous research experience (not a prerequisite)?: Once you submit this application, an e-mail confirmation will be sent to you. It will include all of the information you include here, and will act as your copy of this application. Save the e-mail confirmation for your records. While a resume and letters of recommendation are not required, including them will strengthen your application. When submitting additional materials, please print a copy of your e-mail confirmation and send with additional documents for consideration to: Lupe Zaragoza, Summer Student Research Academy, Dept. of Professional Education, City of Hope, 1500 E. Duarte Road, Duarte, CA  91010-3000. A confirmation will be sent to your email address.