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SUMR Program Application Instructions

  1. Complete the SUMR Program application below.
  2. Submit official transcript(s) from your undergraduate institution(s).
  3. Submit 2 Letters of Recommendation (At least one letter must come from your primary research mentor). Letters may be emailed to mstp@uiowa.edu.

Submit Application Materials to:
SUMR Program
University of Iowa
2206 MERF
Iowa City, IA 52242

The application deadline is February 5, 2010 (applications received after midnight, central standard time, will not be accepted)

You are unable to save this application for completion at a later time. We recommend you use this worksheet to assist you in gathering information prior to starting the application.

2010 SUMR Program Application

PERSONAL INFORMATION:

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First Name:
Last Name:
E-Mail:
How did you hear about the Iowa SUMR Program:

Other:
Permanent Address: Address Line 1
Address Line 2
City
State Zip Code
Phone: ( )
Address at Undergraduate Institution: Address Line 1
Address Line 2
City
State Zip Code
Phone: ( )
Are you a United States Citizen?
Yes No
If "no," are you a permanent U.S. Resident?
Yes No
Date of Birth: (MM/DD/YYYY)
Sex: Male Female
Race and/or Ethnic Origin (optional):
African American
Latino (a)
White
Native American/American Indian
Native Pacific Islander
Other (please specify)

UNDERGRADUATE INSTITUTION(S):

Expected date of graduation: (MM/DD/YYYY)

Undergraduate Institutions Attended (List in chronological order, most recent first)
ONE
Institution
Location
Dates Attended
Major
GPA   Degree  
TWO
Institution
Location
Dates Attended
Major
GPA   Degree  
THREE
Institution
Location
Dates Attended
Major
GPA   Degree  

RESEARCH EXPERIENCE:
Previous Research Experience (List in chronological order, most recent first)
ONE
Dates of Research Experience
Average Hours Per Week
Research Mentor and Institution

Description of the Project Including any Project Accomplishments and/or findings (200 words)

Current number of words remaining:

Your role in the Project (50 words)

Current number of words remaining:

Abstracts or Publications associated with this research experience if applicable (100 words)

Current number of words remaining:

TWO
Dates of Research Experience
Average Hours Per Week
Research Mentor and Institution

Description of the Project Including any Project Accomplishments and/or findings (200 words)

Current number of words remaining:

Your role in the Project (50 words)

Current number of words remaining:

Abstracts or Publications associated with this research experience if applicable (100 words)

Current number of words remaining:

THREE
Dates of Research Experience
Average Hours Per Week
Research Mentor and Institution

Description of the Project Including any Project Accomplishments and/or findings (200 words)

Current number of words remaining:

Your role in the Project (50 words)

Current number of words remaining:

Abstracts or Publications associated with this research experience if applicable (100 words)

Current number of words remaining:


LETTERS OF RECOMMENDATION:

Please give contact information for your two recommenders.

Letters should be sent to:
SUMR Program
2206 MERF
University of Iowa
Iowa City, IA 52242
By e-mail to mstp@uiowa.edu
1st Recommender
Name:
Title:
Address: Address Line 1
Address Line 2
City
State Zip Code/Postal Code
Telephone Number: ( )
Email:
2nd Recommender
Name:
Title:
Address: Address Line 1
Address Line 2
City:
State Zip Code/Postal Code
Telephone Number: ( )
Email:

RESEARCH INTEREST:
What are the areas of research that you would like to pursue in our program (50 words)?

Current number of words remaining:


CAREER PLANS:

Discuss briefly your educational and/or career plans and your reason for interest in MD/PhD training

(250 words): Current number of words remaining:


OTHER INFORMATION:
Add any additional information that may help us evaluate your application:
I certify that the information in this application is true and correct to the best of my knowledge.
Date: (MM/DD/YYYY)