OHSU

2012 Summer Student Research Award

Toxicology Research Center at CROET

Apply Online

INSTRUCTIONS:

This online application consists of two pages. The first page (below) contains your contact information and student profile. The second page consists of three essay questions. It is highly recommended that you prepare your answers to the essay questions before you begin to fill in this form. Once you proceed to the second page you cannot go back, so please double-check all information before proceeding.

Your application will not be complete until you attach a Word file or PDF file containing your transcript. You can optionally submit an additional file containing a letter of recommendation, CV, or any other supporting documentation.

NOTE: Only Oregon residents or those attending colleges in Oregon may apply.

Fields shaded in red and marked with an asterisk (*) are required.

Name and Current Address

*First Name:

*Last Name:

*Current
Mailing Address:

Address Line 2:

*City:

*State:

*Zip:

*Phone:

*Email:

*Email (again):
  [for verification]
 

Disadvantage:
(Women, members of historically underrepresented groups, and economically and educationally disadvantaged applicants are encouraged to apply.)

Permanent Address

Mailing Address:

Address Line 2:

City:

State:

Zip:

Schooling Information

*Current class in school:

Freshman     Sophomore     Junior     Senior

*Accumulated Credit Hours:

(Please enter a number.)

College/Universities Attended (Current school first)

*School:

Dates attended:

Major:

Minor:

Degree:

*Date earned or projected:

School:

Dates attended:

Major:

Minor:

Degree:

Date earned or projected:

School:

Dates attended:

Major:

Minor:

Degree:

Date earned or projected:

Supporting Documentation

Transcript

Additional Supporting Document
50 character limit on filenames
PDF or Word format files only accepted. Make sure the files have a name unique to you, possibly including your name as part of it. Do not use a generic name like 'transcript.pdf' or 'myotherfile.pdf', as your file will not be accepted if its name conflicts with another.

*Date you are available to start the internship: