Summer Undergraduate Research Program
Department of Physiology and Biophysics
Case Western Reserve University
School of Medicine
Starting Date: SURP June 09 – August 1, 2014
NSF-REU May 27 – August 1, 2014*
Name ______
(last) (first) (middle)
College or University Attending ______
Social Security No. ______Email Address ______
College Phone No. ______
College Mailing Address (address good through (mm/dd/yy) ______
(street)
______
(city) (state) (zip)
Permanent Mailing Address ______
(street)
______
(city) (state) (zip)
Permanent Phone No. ______
College Major ______Expected Graduation Date ______
Overall GPA ______GPA in Science Courses ______
Please attach or send a copy of your current transcript
Are you considering applying to: Graduate School ______yes ______no
Medical School ______yes ______no
If you were to choose a major for graduate school today, what would it be? (i.e. what might your thesis topic be?) ______
______
______
Career Goals: (What do you think would be the most interesting career for you? Why does that particular career interest you?) ______
______
______
______
Previous research experience ______
______
______
Honors and Activities (College Only)______
______
______
Are you applying to: SURP Program ______yes ______no
NSF-REU Program ______yes ______no
What in your opinion makes you a suitable candidate for the NSF-REU program?______
______
______
If you are interested in working on projects described in the enclosed brochure, please indicate the research areas of most interest to you or the name of the faculty member (1. = first choice, 2. = second choice, 3. = third choice) below. Other possibilities exist for research projects that are not currently on the Research Descriptions list. Please describe other possible areas of interest to you in blank 4. below.
1. 2.
3. 4.
(Applicant's Signature) (Date)
Please have two professor/advisors in your department send a letter of recommendation under separate cover.
The internships begin May 27 (NSF-REU) and June 09, 2014 (SURP). Both internships end August 1, 2014. These start dates should be considered mandatory. Accommodations for earlier or later starting are possible but should be negotiated with the mentoring faculty and the Course Director.
Work extending beyond the indicated time period may be possible in some laboratories.
Are you interested in housing (room and board) in the dormitory?
Yes No
Applications should be submitted by March 31, 2014. Please return application to:
SURP/NSF-REU Coordinator
Department of Physiology and Biophysics (SURP)
Case Western Reserve University
10900 Euclid Avenue, Cleveland, Ohio 44106-4970
Telephone: 216-368-2084
http://physiology.cwru.edu
* Tentative starting date for this program as the Program is currently under reviewing by the NSF for funding support