UIC
College of Pharmacy
Chicago  Rockford
SURF
SUMMER UNDERGRADUATE
RESEARCH FELLOW (SURF)
2016 APPLICATION FOR SURF FELLOWSHIP
Office of the Dean, M/C 874
University of Illinois at Chicago
833 South Wood Street
Chicago, IL 60612
surf@uic.edu
go.uic.edu/SURF
APPLICANT NAME (Family, Given, MI)
UIN (if UIC student)
PERMANENT LEGAL HOME ADDRESS
CURRENT ADDRESS
MOBILE TELEPHONE
OTHER TELEPHONE
E-mail
DATE OF BIRTH
CITIZENSHIP (check one)
U.S. Citizen (born or naturalized)
U.S. Permanent Resident – Alien Registration Number: A#
GENDER (check one)
Male
Female
RACE/ETHNIC GROUP
Native or Alaskan Native
Asian or Pacific Islander
Black or African American, not of Hispanic origin
White, not of Hispanic origin
Other
Mexican American
Puerto Rican
Cuban
Other Hispanic
EDUCATIONAL SUMMARY DATA
Undergraduate Institution
GPA
/ 4.00
Field of study: Major/Minor
Expected Degree
Expected Graduation Date
RESEARCH INTEREST (find the research areas and SURF faculty on the website go.uic.edu/SURF)
List three (3) SURF Faculty Mentors you would like to work with:
Mentor 1:
Mentor 2:
Mentor 3:
AREAS OF INTEREST Briefly indicate areas of scientific interest and reason for selecting the top 3 mentors.
RESEARCH EXPERIENCE Briefly indicate your research experience, e.g. laboratory courses taken.
UIC
College of Pharmacy
Chicago  Rockford
SURF
SUMMER UNDERGRADUATE
RESEARCH FELLOW (SURF)
2016 APPLICATION FOR SURF FELLOWSHIP
Office of the Dean, M/C 874
University of Illinois at Chicago
833 South Wood Street
Chicago, IL 60612
surf@uic.edu
go.uic.edu/SURF
Instructions
1. SURF Application
Answer all questions on the form. Be sure to specify the areas of research you are interested in.
You may provide further explanation in your personal statement. If you have any questions when
filling your application, contact surf@uic.edu.
2. Choosing a Mentor
Review research profiles of mentors on the SURF website (go.uic.edu/SURF). Select the top 3
mentors you would like to most work with over the summer. If you are selected for our program, all
effort will be made to match you with one of the mentors you selected.
3. Personal Statement/Statement of Purpose
Include a statement of purpose (~1 page) that describes your career goals and plans for study
beyond undergraduate degree (e.g. scientific-based graduate studies, medical school, pharmacy
school, multiple degrees etc.). Explain how research and this program will help you achieve your
goals.
4. Transcripts
Include your undergraduate level transcripts. Unofficial transcripts are acceptable. The transcript(s)
must be provided from any and all institutions of higher learning that you have attended since
graduating high school.
5. Submitting Application and Attachments
Convert the SURF application form, personal statement and transcripts into pdf and assemble them
into single pdf file. If you do not submit your application as a single pdf file, it will not be considered.
Submit the SINGLE pdf file by e-mail to surf@uic.edu by the deadline.
6. Letters of Recommendation
Request two letters of recommendation from academic sources. The letters of recommendation should
be written by current and/or former professors/instructors or advisors, and should convey you interest in
the sciences and research. The letters must be written on official college/university letterhead. Ask
that the letters of recommendation are submitted directly to our program by e-mail to surf@uic.edu as
pdf files by the deadline.
7. Deadline
Deadline to submit your application and letters of recommendation is February 1, 2016. Only
complete applications will be considered.