UIC /

College of Pharmacy

/

SUMMER UNDERGRADUATE RESEARCH FELLOW (SURF)

/

SURF

Office of the Dean, M/C 874

University of Illinois at Chicago

833 South Wood Street
Chicago, IL 60612

go.uic.edu/SURF

Chicago  Rockford

2018APPLICATION FOR SURF FELLOWSHIP
APPLICANT NAME (Family, Given, MI) / UIN (if UIC student)
PERMANENT LEGAL HOME ADDRESS

CURRENT ADDRESS

MOBILE TELEPHONE / OTHER TELEPHONE
E-mail / DATE OF BIRTH
CITIZENSHIP (check one)
U.S. Citizen (born or naturalized)
U.S. Permanent Resident – Alien Registration Number: A#
GENDER (check one) Male Female
RACE/ETHNIC GROUP
Native or Alaskan Native
Asian or Pacific Islander
Black or African American, not of Hispanic origin
White, not of Hispanic origin
Other / Mexican American
Puerto Rican
Cuban
Other Hispanic
EDUCATIONAL SUMMARY DATA
Undergraduate Institution / GPA
/ 4.00
Field of study: Major/Minor / Expected Degree / Expected Graduation Date
RESEARCH INTEREST(find the research areas and SURF faculty on the website go.uic.edu/SURF)
List three (3) SURF Faculty Mentors you would like to work with:
Mentor 1:
Mentor 2:
Mentor 3:
AREAS OF INTEREST Briefly indicate areas of scientific interest and reason for selecting the top 3 mentors.
RESEARCH EXPERIENCE Briefly indicate your research experience, e.g. laboratory courses taken.

Instructions

1. SURF Application

Answer all questions on the form. Be sure to specify the areas of research you are interested in. You may provide further explanation in your personal statement. If you have any questions when filling your application, contact .

2. Choosing a Mentor

Review research profiles of mentors on the SURF website (go.uic.edu/SURF). Select the top 3 mentors you would like to most work with over the summer. If you are selected for our program, all effort will be made to match you with one of the mentors you selected.

3. Personal Statement/Statement of Purpose

Include a statement of purpose (~1 page) that describes your career goals and plans for study beyond undergraduate degree (e.g. scientific-based graduate studies, medical school, pharmacy school, multiple degrees etc.). Explain how research and this program will help you achieve your goals.

4. Transcripts

Include your undergraduate level transcripts. Unofficial transcripts are acceptable. The transcript(s) must be provided from any and all institutions of higher learning thatyou have attendedsince graduating high school.

5. Submitting Application and Attachments

Convert the SURF application form, personal statement and transcripts into pdf and assemble them into single pdf file. If you do not submit your application as a single pdf file, it will not be considered. Submit the SINGLE pdf file by e-mail to by the deadline.

6. Letters of Recommendation

Request two letters of recommendation from academic sources. The letters of recommendation should be written by current and/or former professors/instructors or advisors, and should convey your interest in the sciences and research. The letters must be written on official college/university letterhead. Ask that the letters of recommendation are submitted directly to our program by e-mail to s pdf files by the deadline.

7. Deadline

Deadline to submit your application and letters of recommendation is February 1, 2018. Only complete applications will be considered.