Summer Undergraduate Program in Immunology

Please fill out the following form and then press submit. All additional materials must be mailed to the Immunology Program Office.

 

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Contact Information


Last Name: First Name:

 

Middle Name:

Summer Applying For (Year):

Mailing Address

Street:

City: State:

 

Zip:

Address valid until (MM/YY):

Cell Phone:

Current Phone Number (if different from cell):

Email Address:

Confirm Email Address:

Permanent (Home) Mailing Address

Street:

City: State:

 

Zip:

Phone number:

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Undergraduate Institution


School:

 

Major:

GPA:

Current Year in School:

Expected Grad Date (MM/YY):

 

We would like to know which graduate degrees you are interested in pursuing. Please rank the following degrees 1-4 in order of your interest, 1 being most interested. If you are not interested in a particular degree please select "not interested." If there is another degree you are interested please let us know, and rank it as well.

 

PhD Rank: 


MD/PhD Rank: 


MD Rank: 

 

Masters Rank: 

 

Other:   Rank: 

 

Relevant Coursework:



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Biographical Information


Gender: Male  Female 

 

Social Security #:

Birthdate (MM/DD/YYYY):

Birthplace:

Are you a U.S. citizen? Yes  No 

If no, do you have permanent resident status? Yes  No 

I-551 card number:

Other citizenship (indicate country):

 

Ethnicity (please check all that apply):


African-American     Mexican-American     Puerto Rican    Asian    Caucasian 

Other Hispanic  (specify country)

Native Pacific Islander  (specify island)

Native American  (specify tribal affiliation)

Other  (specify)

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Letters of Recommendation


Letter 1 will be sent by (name):

Letter 2 will be sent by (name):

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How did you hear about the program? (Please check all that apply)


 Home University (or another school) site. Name of school: 

 Online search

 Previous Immunology Summer Participant. Name: 

 Faculty member at your institution

 Other:

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Personal Statement - please copy your personal statement below.


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CV - please copy your CV below.


 

 

Application Information

 

Applications are due by December 15, 2014. Applicants will be notified of admissions decisions via email.

 

Official transcripts and recommendation letters may be sent to:

 

Susan Perkins

Harvard Medical School

Harvard Graduate Program in Immunology

Jeffrey Modell Immunology Center, Room 100D

Boston, MA 02115

sperkins@hms.harvard.edu

 


 

 

 


© 2014 by the President and Fellows of Harvard College