Tulane Xavier MHIRT Program
Applicant Information
2016
University Affiliation
(Tulane, Xavier, other):
Name:
Home Phone: (
)
-
Cell Phone: (
Address:
)
-
Email Address:
City:
State:
Major/ Field
of Study:
Age:
Sex:
Marital Status:
Single
Married
Divorced/
Separated
Widowed
Race/Ethnicity:
Black/
African
American
Asian
American
Hispanic
Native
American
Year in
School:
Sophomore
Junior
Senior
Expected Graduation
Date/Anticipated Degree:
Citizenship Status:
Masters/MPH
M
Zip:
F
Other:
Doctoral/PhD
Med School
Current
GPA:
U.S. Citizen
Permanent Resident
What career plans do you have following
the completion of your program (e.g.,
teaching, medical school, research, etc.)?
Response limited to 700 characters.
Applications should be submitted via email to Andrea Meyer, Project Director, at ameyer1@tulane.edu.
Letters of recommendation should be placed in a sealed envelope and hand-delivered or sent by mail to Andrea
Meyer at the Tulane SPHTM or Dr. Elliott Hammer at Xavier University. See the MHIRT website for addresses.
Letters of recommendation may be emailed to Ms. Meyer if they come directly from the reference and not from
the applicant.
The deadline for applications for the MHIRT 2016 program is Friday, February 5, 2016 at 5:00 p.m. No applications
will be accepted after the deadline.
Please note that each response below is limited to 1,600 characters. If you need additional space, please
continue your answers on a separate page and include it with your application.
1. List any classes you have taken that have trained you in the research process.
Response limited to 1,600 characters.
2. Have you studied a foreign language? If so, which one, and for how long? How would you rate your own level of
proficiency in that language? Response limited to 1,600 characters.
3. What specific skills do you have that may serve you in carrying out the research project (e.g., expertise in
computerized data analysis, such as with SPSS, SAS, or a related program, laboratory experience outside the
classroom, etc.)? Response limited to 1,600 characters.
4. What sorts of research interests do you have that you would like to explore through this opportunity?
Response limited to 1,600 characters.
5. Have you ever traveled outside of the country? If so, please detail where and in what capacity.
Response limited to 1,600 characters.
6. Following is a list of opportunities available for student collaboration this summer. Please rank your top three in
order of your preference (1-3). Additional information on these positions can be found on the “Summer 2016
Opportunities” page on the website.
Site Locations:
Argentina #1
Mexico #1
Argentina #2
Peru #1
China #1
Peru #2
China #2
Peru #3
Cuba #1
Cuba #2
7. Because you are applying to MHIRT, you must have some interest in interacting with other cultures. Some people are
more comfortable in different environments than others, and some of our MHIRT placements are more similar to what
you would experience in the U.S. than are others. We would like to assess the degree to which such unfamiliarity and
inconveniences would affect your experience.
Using the scale below, rate yourself on each of the following items according to the degree to which you anticipate
discomfort with that issue. Please be honest, as no particular response will preclude your participation in the MHIRT
program.
1
Would not bother me
at all
2
3
4
Extreme heat (~120 degrees Fahrenheit)
Please explain your answer.
Relatively primitive sanitation/plumbing (outdoor facilities; lack of running water)
Please explain your answer.
Language & cultural barriers
Please explain your answer.
Lack of privacy
Please explain your answer.
5
Would bother me a
great deal
Bouts of illness from food or water contamination or malaria
Please explain your answer.
Inaccessibility to communication back home
Please explain your answer.
Restrictions on personal freedom (such as going out at night)
Please explain your answer.