Maryland Psychiatric Research Center/
Silvio O. Conte Center for Translational Neuroscience Research
Undergraduate Research Program
Summer 2015 Application
Program Dates: Starting June 1, 2015 and ending August 7, 2015. Participants must attend the formal Orientation Session on June 1, 2014.
Deadline for application: midnight of February 28, 2015
A complete application requires the following documents:
1. A complete application form
2. An unofficial copy of your college or university transcript
3. A copy of your CV or resume
Items 1-3 should be submitted as one pdf file to mprc.conte@gmail.com
4. Two letters for recommendation from professors or advisors that can assess your potential and/or ability to conduct
research. Letters must be sent directly to mprc.conte@gmail.com
PERSONAL INFORMATION
Full Name:
(Optional) Sex:
(Optional) Race/Ethnic Identification
AMERICAN INDIAN or ALASKA NATIVE – (Not Hispanic or Latino)
BLACK or AFRICAN AMERICAN – (Not Hispanic or Latino)
ASIAN – (Not Hispanic or Latino)
HISPANIC or LATINO
WHITE – (Not Hispanic or Latino)
NATIVE HAWAIIAN or OTHER PACIFIC ISLANDER – (Not Hispanic or Latino)
TWO or more RACES – (Not Hispanic or Latino)
UNKNOWN
CURRENT ADDRESS
Street:
City:
Phone (day):
Phone (evening):
Will be at this address until:
State:
Zip:
State:
Zip:
/ /
PERMANENT ADDRESS
Street:
City:
CITIZENSHIP
Are you a US citizen or permanent resident?
Yes
No
If not permanent resident, what visa type?
EDUCATIONAL BACKGROUND
Institution:
Location:
Major:
Grade Point Average:
Out of:
Anticipated Date of Graduation (Month and year):
Current year in School (please circle):
Freshman
Sophomore
Junior
Senior
REFERENCES
Letters of Reference requested from:
Name:
Institution:
Email:
Name:
Institution:
Email:
Describe your career goals, research interests, and expectations for a summer research experience (no longer than
250 words).
Briefly describe previous full, part-time or summer positions and research experience:
Which of the following research opportunities are you most interested in:
Research in a preclinical laboratory (i.e. working with rodent models, behavioral studies, biochemical and molecular analysis, etc)
Research in a clinical laboratory (i.e. studies involving human subjects)
How did you learn about our program?
All materials must be received by February 28, 2015.
Applicants will be informed of their final status by the end of March.
For questions, please contact our Program Director:
Ana Pocivavsek, Ph.D.
Maryland Psychiatric Research Center
University of Maryland School of Medicine
Telephone (410) 402-7751
Email address: apocivavsek@mprc.umaryland.edu
THANK YOU FOR YOUR INTEREST IN OUR PROGRAM!
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