UA MARC PROGRAM APPLICATION

Please TYPE all of the information requested. You can receive an application electronically by contacting Dr. Tischler (tischler@email.arizona.edu). The completed application can be brought to Cindy Neal's office (Biosciences West 202A) or e-mailed to Dr. Tischler as a file attachment or mailed to Cindy Neal/MARC Program at Department of Biochemistry, PO Box 210088, Tucson, AZ  85721. Application deadline is February 2, 2009.

Name:

Local address:

Telephone:

Permanent address:

Telephone:

Email:

Citizenship (citizen or non-citizen national of the US or lawfully admitted for permanent residence):

Major:

Minor (if applicable):

Name and contact information (e-mail address and/or telephone number) for 1 or 2 references, other than family or family friends.

GPA in science and mathematics (as of the time of application: 4-year institutions only):

GPA overall (as of the time of application : 4-year institutions only):

Expected date of graduation:

How did you hear about the MARC program?

On a separate page list ALL (both from 4-year and 2-year institutions) Science and Mathematics courses completed as of the time of application and in progress, indicating where the course was/is being taken and, where available, the course grade received.

On a separate page(s) fully describe each of the following that is relevant to you. If it does not pertain to you then simply state that.

a)  Explain how you feel you meet the criteria of under represented status in biomedical research (you must provide a response):

b) Tutoring experience (if any) including the nature of your experience(s) including supervisors to contact

c) Independent study experience (if any) including the nature of your experience(s) including supervisors to contact

d) Research experience (if any) including a full description of the experience(s), with whom conducted and how it has reinforced your interest in a biomedical research career.

e) Other science-related activities (if any) including outreach to public or private schools; science fair judging; Science Connection; etc.

f) Awards, scholarships or special recognition you have received (if any)

On a separate page (2 pages maximum) discuss in as much detail as possible your career plans in terms of interest in a biomedical research career including in what area(s) of research you may be interested and your current intentions for graduate education leading to a doctorate in a biomedical field (in the broadest sense).