K12 Masters Degree in Clinical Investigation
Admission for July 2009
Application Deadline is January 1, 2009
INSTRUCTIONS: DOWNLOAD APPLICATION FROM STSI WEBSITE
FILL IN ALL FIELDS WITHIN APPLICATION
SAVE AND EMAIL APPLICATION PLUS ANY SUPPORTING DOCUMENTS TO: STSI@SCRIPPS.EDU
TRACK
Genomic Medicine
Wireless Medicine
General
PERSONAL INFORMATION
Name (Last, First, MI)
Current Mailing Address
Permanent Address
E-mail Address
Telephone
Sex: M F
Ethnicity: African American
Native American
Pacific Islander
Hispanic
Caucasian
Asian
Decline to state
FELLOWSHIP & RESIDENCY TRAINING
Fellowship (Specialty/Institution): Start Date: Date of Completion: Program Director:
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Residency (Specialty/Institution):
PUBLICATIONS
Authors
UNDERGRADUATE EDUCATION
University Major
RESEARCH EXPERIENCE
Relevant Scientific Positions
(Name/Location)
Job Title
Title
Start Date: Date of Completion:
Degree
Program Director:
Dates of Employment/Research
Activity
Research Supervisor/Director
Journal
Dates of Attendance
Citation
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LETTERS OF RECOMENDATION
TWO letters required. One letter should be from Fellowship or Residency Director. Second letter should be from research mentor or other faculty personnel.
Name of Reference Affiliated Institution
STATEMENT OF PURPOSE
Submit within the enclosed borders a personal statement which describes your purpose in seeking a Masters Degree in Clinical Investigation. Please delineate your long term career goals, your research experience, and your rationale for pursuing this degree particularly at the Scripps
Translational Science Institute.
The Statement of Purpose section should be no longer than 1 – 1 ½ pages with 10 – 12pt font size.
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