Full Application Form
Application Deadline January 31, 2015
Idaho INBRE
Summer 2015 Undergraduate Fellowship Program
Note: To be eligible for an INBRE Undergraduate Summer Fellowship, you must be graduating
with a Bachelor’s degree no earlier than December 2015. Students graduating with a Bachelor’s
degree in May or August 2015 will not be eligible in 2015.
Choose the Institution you are applying to:
a.
Boise State University
b.
Idaho Veterans Research and Education Foundation (Boise VA)
c.
Brigham Young University - Idaho
d.
The College of Idaho
e.
College of Western Idaho
f.
Idaho State University
g.
Lewis-Clark State College
h.
North Idaho College
i.
Northwest Nazarene University
j.
University of Idaho
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:
Expected Month and Year of Graduation:
Phone:
Current Grade Point Average:
Email:
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
Are you an Idaho resident? Yes or No
Race and Ethnicity: We are required by Federal law to request this information for statistical
reporting purposes. Your response is voluntary.
Do you consider yourself to be Hispanic/Latino(a)? Yes or No
Select one or more of the following racial categories to describe yourself:
American Indian
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Other (please specify):
What are your current education and career plans? If you are currently a student at a
community college, do your plans include transferring to another Idaho school to complete your
Bachelor’s degree? If you are planning to go to graduate school, are you considering enrolling in
an institution in Idaho?
Describe the research experience you have had.
What do you hope to gain from an INBRE Summer Research Fellowship?
Write a statement about obstacles you have overcome to pursue your educational goals.
Name and contact information of your mentor: (Idaho State students skip this section
and fill in names below)
Name:
Email:
Idaho State students fill in the name of three possible Mentors:
Idaho State University
1.
2.
3.
Name and contact information of reference(s). Two references are required (LCSC
students, please list 3 references). Your Mentor may also be a reference.
Name:
Email:
Name:
Email:
Name:
Email:
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, 2015
Summer 2015 Undergraduate Fellowship Program
Steps to submit the Fellows Application packet:
1. Be a student enrolled at an Idaho college or university who will be graduating with a
Bachelor’s degree on or after December 2015. Students graduating in May or August
2015 will not be eligible in 2015.
2. Complete the Fellows application form.
3. Choose a mentor for a biomedical research project. Students may choose from the
Faculty Mentors list on the website or from any faculty member active in biomedical
science.
4. Contact your Mentor of choice and confirm that he/she agrees to mentor you if you are
chosen as an INBRE Fellow for 2015. If required by your institution, with the chosen
mentor, prepare a Summer Research Plan describing the 10-week summer research
project.
5. Assemble and submit the application packet. Packet must include an application form, a
copy of the most current transcript (unofficial is acceptable), and the Summer Research
Plan (if required).
6. Request two confidential letters of reference. LCSC students ONLY– write 3 names on
your application, letters are not required. One of the may be your mentor. References
must be submitted via the online form at inbre.uidaho.edu/references. References are
due by the application deadline of January 31, 2015.
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 packet, letters of reference, by the due date of January
31, 2015. 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.