INBRE Southern Nevada

Biomedical Exploration Workshop Application
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Biomedical Exploration Workshop Application

June 13-July 15 2011- Application Due May 1, 2011

Contact Information

Your Name

Your Email

Your phone number with area code

Mailing address

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?

Demographic/Background/Educational Questionnaire

Your birthdate

What is your gender?

Male
Female

What is your race? (check any that apply)

Hispanic or Latino
American Indian / Alaska Native
African or African American
Asian or Asian American
Native Hawaiian or other Pacific Islander
White

Are you a first generation college student (your parents did not earn a college bachelor’s degree)?

How many college credits have you earned (not including the current semester)?

Attach a copy of your college transcripts

From what college(s) have you earned these credits?

Letter of Recommendation

One letter of recommendation is required from a past or present college instructor. Print the recommendation form (.pdf) and give to your chosen instructor. The instructor will return 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 background and interests. Explain why you are interested 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

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Biomedical Exploration Workshop Application