Biomedical Exploration Workshop Application

Biomedical Exploration Workshop Application

June 11-July 13 2012 - Application Due April 16, 2012

Contact Information

Your Name

Today's date

Just leave it on default for today's date.

Your Email

Mailing address

Your phone number with area code

Your NSHE ID*

*This is your unique ID number used by Nevada colleges and universities.

Citizenship and Legal Residency
(you must answer yes to both questions to be eligible for the program)

Are you a legal US citizen or permanent, legal resident?

Do you have a valid US social security number?

Letter of Recommendation

One letter of recommendation is required from a past or present college instructor. Print the recommendation form (MS Word file) and give to your chosen instructor. The instructor will return the form directly to the Biological Sciences Department at CSN.

Name of your reference

What course did you take from this instructor?

Program Interest Essay

Write a short essay (100-1000 words) describing your educational background and interests. Explain why you would like to participate in the Biomedical Exploration Workshop. Please type your essay and attach it to the application.

Attach your essay

The information in this application is true, accurate and complete to the best of my knowledge. If there is intentional falsification of information on this application , I understand that this would be cause for immediate cancellation of admission to the Biomedical Exploration Workshop and forfeiture of monies granted.

I agree
I do not agree

I understand that the award of $1,400 is contingent upon my attendance and completion of assignments within the workshop. I also understand that compensation is at the end of the workshop and I will be required to submit paperwork for payment.

I agree
I do not agree

Human test

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If you cannot get this online application to work properly you may download this application form to print out and mail in.