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 Indicates items that are required for submission. |
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| Which Program(s) are you applying for: Program Eligibility |
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Undergraduate Research Access for Minorities Program (URAMP)
Focus on underrepresented students
Summer Undergraduate Research Program (SURP)
Focus on all qualified students with a special emphasis on underrepresented students
Utah Summer Undergraduate Research Program (USURP)
Focus on Utah residents not currently attending the University of Utah
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| First Name: |
| Middle Name: |
| Last Name: |
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| Current Contact Information |
| Address: |
| City:
State:
Zip: |
| Current Cell Phone #:
(XXX) XXX-XXXX |
| Current Home Phone #:
(XXX) XXX-XXXX |
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| Permanent Contact Information |
| Address: |
| City:
State:
Zip: |
| Permanent Phone #: (XXX) XXX-XXXX |
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| Email Address: |
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Ethnicity: (Please check all that apply) |
American Indian or Alaskan Native
Asian
Black or African-American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Other
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| Residency: U.S. Citizen
Permanent Resident
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| Date of Birth: (MM/DD/YYYY) |
| Gender: Male
Female
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| Current College Information |
| Current College/University: |
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| Highest Degree that your College/University Offers: |
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Bachelors
Masters
Ph.D.
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| Current Class Standing: |
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Freshman
Sophomore
Junior
Senior
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| Anticipated Graduation Date: |
| Major: |
| Overall GPA:
Major GPA: |
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Are you planning to attend graduate school?
Yes
No
Are you planning to attend medical school?
Yes
No
Are you planning to attend a MD/PhD program?
Yes
No
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| Please state any additional information you'd like us to know: |
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| Indicate courses you have taken that are related to the academic and research area of your choice: |
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| Please upload your Personal Statement. In 500 words or less, the reason for applying to the summer research program, the research you are interested in conducting, any technical skills you posses, any previous research experience, and what you hope to gain from this program. (Word, rich text, WordPerfect, PDF formats accepted.) |
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| The University of Utah is fully committed to a policy of nondiscrimination and equal opportunity in all programs activities and employment without regard to race, color, religion, national origin, sex, age or status as a handicapped individual, disabled veteran or veteran of the Vietnam era. Evidence of practices that are not consistent with this policy should be reported to the Office of the President of the University, (801) 581-8635.
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| I hereby certify to the best of my knowledge that all information submitted is complete and accurate. I understand that disclosing false information may be grounds for dismissal from the program. By means of checking the box below, I grant permission to release my name, address, transcript, and the information in this application to an appropriate selection committee. |
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I agree
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