APPLICATION FORM
Summer Microbiology and Research Training Program (SMaRT)
NSF Microbial Observatories on Marine Sponges (MOMS)
Center of Marine Biotechnology (COMB)
University of Maryland Biotechnology Institute
Baltimore
Please fill out all sections of the application. Information on this form will be used to evaluate candidates.
Applications should be submitted by April 14, 2006 for full consideration (early applications are encouraged). The course runs from 10th to 19th July, 2006.
An official academic transcript from your home institution and two letters of recommendation MUST be sent with the application.
1. Applicant Information
Name (Last, First, Middle Init.):
Soc. Security No.: Citizenship: (US Citizens and permanent residents only)
Date of Birth: / / Gender: Female Male
Permanent Address (of Parent or Legal Guardian):
Name of Parent or Other Contact:
Street Address:
City: State: Zip Code
Telephone (+ Area code):
Current Address (if different from above):
Street Address:
City: State: Zip Code
Telephone (+ Area code):
E-mail address:
Minority Status:
American Indian Alaskan Native
Provide tribal affiliation for Amer. Indian/Alaskan:
African American Asian
Hispanic or Latino Pacific Islander
Puerto Rican
Other (Provide details: )
II. Educational Information:
Current Institution:
Major(s): GPA in Major:
Minor(s): Overall GPA:
College Class: First Year credit hrs earned
Soph. credit hrs earned
Junior credit hrs earned
Projected graduation date: / (Month/Year)
SAT or ACT scores:
Academic Advisor:
Name: Tel. No. (+ Area Code):
Dept. and Campus Address:
E-mail address:
Area(s) of interest for graduate study:
Contact Information for Reference Letters:
1. Name: Tel. No. (+ Area Code):
Address and Institutional Affiliation:
E-mail address:
2. Name: Tel. No. (+ Area Code):
Address and Institutional Affiliation:
E-mail address:
Academic and Extracurricular Awards, Honors and Scholarships (list by year):
Membership or participation in academic/campus organizations and activities (list by year):
Previous research experience (year, institution, faculty mentor, research topic):
*** Please attach copies of any publications (papers, conference abstracts, other written work) generated from your activities to your application or indicate relevant web site URLs.
Research Interests and Intention to Attend Graduate School (use the space provided below to briefly discuss these issues):
Submit completed application form, transcript and two letters of recommendation to:
Russell T. Hill, Ph.D
Center of Marine Biotechnology
University of Maryland Biotechnology Institute
701 East Pratt Street
Baltimore, MD 21202