Undergraduate Research

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Application For UndergraduateResearch

and/or Laboratory Experience

PLEASE TYPE ONLY WITHIN TEXT BOX MARGINS

Title:                              Mr.       Mrs.        Ms.       Dr.

 Last name

 First name

UM Student ID

 

 Current address

 at school  (if

 living  on campus)

 City

 State

 Zip Code

 Phone

 Permanent

 Home address

 Address (cont.)

 City

 State/Province

 Zip/Postal code

 Country

 Home Phone

 Cell Phone

 E-Mail

 

Current Grade Level:

 

High School:  Fresh.        Soph.        Jr.          Sr.

 

College:         Fresh.        Soph.        Jr.          Sr. 
                     Masters     Ph.D.         M.D.     Post Bacc

 

 

 

If requesting a science based internship, please list high school or undergraduate science courses taken:

Major:

Minor:

 

Are you in the Honors Program?          

Yes                                   

No

 

Career Goals:

 

 

Research Areas of Interest:

 

Previous Lab and /or Research Experience:

 

 

Availability: Please list months, days and hours available:

 

 

Are you willing to take a voluntary position?

Yes
No

 

As a UM Undergraduate Research Intern, I give my consent to use my photo and/or reports of my research experiences to be used for future publication by the University of Miami, Office of Undergraduate Research.

Yes

No

           

WHEN COMPLETE PLEASE PRINT AND FAX THE APPLICATION ALONG WITH AN UNOFFICIAL TRANSCRIPT AND YOUR ACADEMIC RESUME TO: (305) 284-8278
or deliver the documents along with your application to:

Dr. Michael S. Gaines

  Assistant Provost

Office of Undergraduate Research and Community Outreach

1301 Memorial Drive,  Cox Science Center, Room 122

Coral Gables, FL 33146-0480

Phone: (305) 284-5058

Fax: (305) 284- 8278

m.gaines@miami.edu

 

 

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