The Ohio State University and Howard Hughes Medical Institute
Med into Grad Scholars Program
2015-2016 Fellowship Application
PERSONAL INFORMATION
LAST NAME:
FIRST NAME:
OSU EMAIL:
PHONE:
OSU ID:
GENDER:
Female
EDUCATIONAL INFORMATION
GRADUATE PROGRAM:
RESEARCH ADVISOR:
RESEARCH ADVISOR DEPT:
GRADUATE GPA:
UNDERGRADUATE INSTITUTION:
UNDERGRADUATE MAJOR:
UNDERGRADUATE GPA:
MA/MS:
MA
MS
N/A
MASTERS GPA:
TEST SCORES
GRE ATTEMPTS:
GRE SCORE:
GRE-QUANTITATIVE:
GRE-VERBAL:
GRE-ANALYTICAL:
AREA OF RESEARCH
BIOMEDICAL ENGINEERING
COMPUTATIONAL BIOLOGY
GENETICS
INFECTIOUS DISEASES
NEUROSCIENCE
RNA BIOLOGY
Male
OSU HHMI Med into Grad Fellowship Application 2015-2016
RESEARCH PROPOSAL
(not to exceed two pages)
TITLE:
AREA OF RESEARCH:
HYPOTHESIS:
SPECIFIC AIMS:
RESEARCH PLAN:
BACKGROUND & SIGNIFICANCE
PRELIMINARY DATA:(OPTIONAL)
EXPERIMENTAL PLAN:
SUMMARY:
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OSU HHMI Med into Grad Fellowship Application 2015-2016
PERSONAL STATEMENT
(not to exceed one page)
Briefly outline your career aspirations and motivation for applying to the OSU HHMI MED into GRAD Scholars Program.
Describe program expectations and interest in particular didactics or clinical experiences. Please limit response to no more than
1 page.
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OSU HHMI Med into Grad Fellowship Application 2015-2016
APPLICANT BIOGRAPHICAL SKETCH
(not to exceed four pages)
NAME OF FELLOWSHIP APPLICANT
POSITION TITLE
Email address:
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include
postdoctoral training.)
DEGREE
INSTITUTION AND LOCATION
YEAR(s)
FIELD OF STUDY
(if applicable)
A. Positions and Honors
ACTIVITY/OCCUPATION
BEGINNING
DATE
(mm/yy)
ENDING
DATE
(mm/yy)
FIELD
INSTITUTION/COMPANY
SUPERVISOR/
EMPLOYER
B. Academic and Professional Honors
C. Publications
D. Scholastic Performance
SCIENCE
YEAR
COURSE TITLE
OTHER
GRADE
YEAR
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COURSE TITLE
GRADE
OSU HHMI Med into Grad Fellowship Application 2015-2016
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OSU HHMI Med into Grad Fellowship Application 2015-2016
ADDITIONAL MATERIALS CHECKLIST (submit with application)
Applicant’s biographical sketch (sample posted on web)
Research advisor’s NIH biographical sketch or CV (4 page limit)
Letter of support from research advisor addressing the scientific potential and training plan of the
applicant
Letter of support from any additional research mentor (optional)
Program Director Evaluation* (found on the web): medicine.osu.edu/go/hhmi
*If student waives his/her right to view the completed evaluation, Program Director should email directly
to amy.lahmers@osumc.edu
APPLICATION DEADLINE: 5:00 PM April 17, 2015
All application materials should be emailed to: amy.lahmers@osumc.edu
medicine.osu.edu/go/hhmi
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