Full Application Form Application Deadline January 31, 2016 Idaho INBRE 2016 Summer Western INBRE Visiting Fellow Program Note: To be eligible for an INBRE Undergraduate Summer Fellowship, you must be graduating December 2016 or later. Students graduating in May or August 2016 will not be eligible in 2016. The Western INBRE Visiting Fellow Program at the University of Idaho is an opportunity for undergraduate students from Alaska, Hawaii, Montana, New Mexico, Nevada, or Wyoming to participate in an intensive 10-week summer research experience in the laboratory of an Idaho researcher. Enter name and contact information where we will be able to reach you in March/April. Please enter your current education information: Name: Current Educational Institution: Complete Address: Major: Phone: Expected Month and Year of Graduation: Email: Current Grade Point Average: Where did you graduate from high school? Name of High School: City: Zip: State: Please enter your full permanent residence address (non-school hometown): City: Street: State: Zip: What is the highest level of education your parents have attained? (Please enter one choice for each parent – High School, Some College, Assoc. Degree, BA or BS, MA or MS, PhD, MD, or any other degree as appropriate. Mother: Father: What is your gender? M or F Are you a citizen or permanent legal resident of the United States? Yes or No What are your current education and career plans? If your plans include graduate school, will you consider enrolling in an institution in Idaho, Alaska, Hawaii, Montana, New Mexico, Nevada, or Wyoming? Describe the research experience you have had. What do you hope to gain from an INBRE Summer Research Fellowship? Please write a statement about obstacles you have overcome to pursue your educational goals. Select up to three mentors from the school(s) you would like to apply to: University of Idaho 1. 2. 3. Boise State University 1. 2. 3. Idaho State University 1. 2. 3. I certify that I fully understand the questions on this form and that information given in this application is true and correct. If I am selected as an INBRE Fellow, I give the INBRE program permission to include my name, institution, major and hometown in statewide press releases announcing all Fellows. Name: Date: Submission Instructions Application Form Idaho INBRE Application deadline January 31, 2016 Summer 2016 Western INBRE Visiting Undergraduate Fellow Program Steps to submit the Fellows Application: 1. Be a student enrolled at a college or university in Alaska, Hawaii, Montana, New Mexico, Nevada, or Wyoming who will be graduating on or after December 2016. Students graduating in May or August 2016 will not be eligible in 2016. 2. Complete and submit the application form. 3. Attach current transcripts Transcripts can be obtained through the Registrar’s office of institutions attended by the applicant. Unofficial transcripts may be used, but formatting must be easily readable. 4. Two confidential letters of reference USING the online REFERENCE FORM found on the Fellows application page. Request two confidential letters of reference. Please ask letter writers to complete the reference form online at http://inbre.uidaho.edu/references. Once your letter writer creates an account they will be able to save the reference forms they are working on. Submitted references are due by the application deadline, January 31, 2016. The Idaho INBRE Fellowship program is a competitive program. The number of applications we receive will exceed the available Fellowships. In order to be considered for a Fellowship we must receive your completed application including transcripts and letters of reference by the due date of January 31, 2016. We cannot consider incomplete packets. If you have questions, or difficulties completing this form, please contact the INBRE office at (208) 885-5373 or inbre@uidaho.edu. The Idaho INBRE Program is supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health by Grant #P20GM103408.