Second Summer Student Application
Instructions:
(1) Application and supporting documents are
due
in
mid-March
of each year.
(2)
This
online application cannot be edited after submission
. As a result, we recommend you
print these pages now
, and complete the fields on paper before you enter them here.
(3)
Required supporting documents
: Prior to mid-March, the following materials
must be
faxed to 301- 402- 3034.
Otherwise, your application will be considered incomplete.
Last semester's
transcript
Two
new letters of recommendation
A new
resume
including expected graduation date and new lab experience
A written
Research Plan
(one page maximum)
(4) Questions should be emailed to
Ms. Gloria Seelman
.
Indicates a required field!
1. Personal Information
Name:
First
MI
Last
Home Address:
City:
Zip:
Home Phone:
Date of Birth:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
/
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
Age:
E-mail Address:
userid@server.com
To obtain a free email address, click
here
Gender:
select
female
male
Citizenship Status:
United States Citizenship
Permanent Resident
If Permanent Resident, Alien Registration #:
Current School:
Social Security #:
Class Next School Year:
select
Junior
Senior
2. Health Information:
Please complete the following.
Health Insurance:
Name of Carrier
Policy Number
3. Previous Internship Information
NIH Institute :
Lab Address:
Lab Telephone:
Dates of Employment:
(6-8 consecutive weeks)
Administrative Officer:
(ask your preceptor if necessary)
Phone Number:
Preceptor's Name:
Please click on the "Submit Application" button below to complete the application.
fields are required to be filled in order to submit an application.
Notice to all applicants:
Applicants are advised to ensure that all information is accurate. False or inaccurate information contained in this application may be grounds for denying your candidacy or removing you from the program.