2014 Anthony and Theresa Zannoni SURF Program Application

Instructions

Please complete all the fields below, entering "n/a" for any field that is not applicable, then submit your completed form.

Important Information

Your application is not complete until a copy of your transcript and a letter of recommendation from a faculty member have been submitted to Dr. Rennolds Ostrom, University of Tennessee Health Science Center, 874 Union Ave., Crowe 115, Memphis, TN 38163 or via email rostrom@uthsc.edu.

Unofficial transcripts printed from a school's online system are acceptable. Letters of reference should be sent directly from your referee.

Section I

First Name: Last Name:

Telephone (w/ area code):

E-mail Address: Date of Birth:

Current Address:

City: State: Zip:

Are you a US citizen or permanent resident?

Home Country:

Summer Dates Available:

Section II

Prior Education

Major: Minor (if any):

Institution:

City:

Degree To Be Awarded:  Classification in Fall 2014:

Expected Graduation Date:

Please list all Chemistry, Biology, and Math courses taken. Include credit hours, lab courses, and grades:

1500 characters left

On a 4.0 scale, GPA Overall:  Chemistry:  Biology:  Math:

Briefly describe your career or educational plans after graduation:

500 characters left

In one paragraph, explain why you would like to participate in this research program:

500 characters left

Have you had previous experience in scientific research? If yes, please provide a brief description of the research:

500 characters left

Faculty Member Writing Letter of Reference: Email:

Section III

To complete the submission of your SURF application form, in the space provided below, please type in the 2 words pictured, then click the "Submit" button. Thank you for your submission.