M.I.: Last Name:
Date of birth (mm/dd/yy):
Graduation date (mm/dd/yy):
GRE score: Test Date (mm/dd/yy):
Current mailing address:
City: State: Zip:
Daytime Phone: Evening phone:
Mailing address after (give date: mm/dd/yy):
City: State: Zip:
Daytime Phone: Evening phone:
Where did you learn about this program?:
Are you a U.S. citizen?: Yes:
If you answered no, are you a permanent resident?: Yes: No:
(You be a citizen or permanent resident to participate in this program.) must
Please indicate the group(s) in which you would include yourself (check all that apply):
Hawaiian/Pacific Islander (Please specify):
Native American/Alaskan Native
Other (Please specify):
Are you disabled?: Yes:
What is the highest level of education attained by your parents or guardians?
Are you from a disadvantaged background?: Yes:
If yes, please describe your disadvantaged status:
*Disadvantaged background status is defined by the National Institutes of Health as:
Individuals who come from a family with an annual income below established low-income thresholds. These thresholds are based on family size; published by the U.S. Bureau of the Census; adjusted annually for changes in the Consumer Price Index; and adjusted by the Secretary for use in all health professions programs. The Secretary periodically publishes these income levels at http://aspe.hhs.gov/poverty/index.shtml. For individuals from low income backgrounds, the institution must be able to demonstrate that such participants have qualified for Federal disadvantaged assistance or they have received any of the following student loans: Health Professions Student Loans (HPSL), Loans for Disadvantaged Student Program, or they have received scholarships from the U.S. Department of Health and Human Services under the Scholarship for Individuals with Exceptional Financial Need.
Individuals who come from a social, cultural or educational environment such as that found in certain rural or inner-city environments that have demonstrably and recently directly inhibited the individual from obtaining the knowledge, skills, and abilities necessary to develop and participate in a research career. Recruitment and retention plans related to a disadvantaged background are most applicable to high school and perhaps to undergraduate candidates, but would be more difficult to justify for individuals beyond that level of academic achievement.
Rank your preferred area of interest from 1 (most preferred) to 6 (least preferred):
First choice Behavior/Human Factors Biomedical Engineering/Human Factors Genetics/Cell Biology Genetics Epidemiology Integrative Biology/Toxicology Neuroscience
Second choice Behavior/Human Factors Biomedical Engineering/Human Factors Genetics/Cell Biology Genetics Epidemiology Integrative Biology/Toxicology Neuroscience
Third choice Behavior/Human Factors Biomedical Engineering/Human Factors Genetics/Cell Biology Genetics Epidemiology Integrative Biology/Toxicology Neuroscience
Fourth choice Behavior/Human Factors Biomedical Engineering/Human Factors Genetics/Cell Biology Genetics Epidemiology Integrative Biology/Toxicology Neuroscience
Fifth choice Behavior/Human Factors Biomedical Engineering/Human Factors Genetics/Cell Biology Genetics Epidemiology Integrative Biology/Toxicology Neuroscience
Sixth choice Behavior/Human Factors Biomedical Engineering/Human Factors Genetics/Cell Biology Genetics Epidemiology Integrative Biology/Toxicology Neuroscience
Please provide a response to each of the following questions. Your response may not exceed 300 words per question.
1. What person or event has been most influential in the development of your science career? (You should describe a person or situation that propelled you toward your career path in science or research in 300 words or less.)
2. Discuss your specific interest in pursuing a career in biomedical , behavioral or social science health-related research and your academic and career goals. Describe how the GRAD-PREP would help you attain your goals, including the non-financial benefits you may attain from the program. (300 words or less)
3. In responding to the following questions be sure to only include those activities and awards that are relevant to your interest in science and biomedical research.
a. Describe extracurricular activities in which you have participated in the past or are participating in currently. (For example-science fairs, science clubs, internships, community service, hobbies). Describe the specific role you played in the activities. (300 words or less)
b. List special recognitions, scholastic awards and honors, and any scholarships you have received. Include a short narrative to help us understand the award, scholarship, or recognition. (300 words or less)
c. Describe any activities, whether voluntary or paid positions, that demonstrate involvement with and/or commitment to biomedical, behavioral or social science health-related research which you participated in during the school year or summer. If you engaged in research, describe the specific role you played in the research project and include references of any abstracts or publications of which you are an author that may have resulted from the research. (300 words or less)
The following items also must be submitted before your application will be considered:
Official copies of transcripts from all undergraduate institutions should be sent by U.S. Mail to the Academic Transcript(s). address below.
Submit two faculty recommendation forms completed by science academic faculty (provide their names and e-mail addresses below). The forms are part of the Word and PDF versions of the application linked on Letters of Recommendation. "How to Apply" page.