Hawaii INBRE III – HiSREP
Summer 2015 Undergraduate Student Research Experiences (SRE)
Application (New)
Application Deadlines:
Summer- May 20, 2015
Fall- September 8, 2015
Spring- January 18, 2016
Students will perform a semester-long research internship, working in his or her
research mentor’s laboratory.
Upon completion of INBRE research experience, students will be required to write a
short scientific research paper by the end of Spring semester, May 2016, in addition
to presenting a research poster at the JABSOM Biomedical Symposium next Spring.
**Note that all INBRE participants will be contacted for periodic follow-up of academic and
career plans and goals. Long-term tracking (5 or more years out) of all INBRE participants
after their involvement in the program is required by the INBRE program. Therefore, all
student interns will be requested to provide permanent contact/information as well as
expected to participate in all surveys/questionnaires from INBRE.
Eligible students:

Undergraduates with a 2.75 cumulative GPA who have completed at least their
freshman year of a four-year degree in the biomedical or bio-behavioral sciences;
OR
 Community college students with a 2.75 cumulative GPA who have completed at least
one year of their program of study.
Note: These eligibility requirements may only be waived upon assessment by the Campus Coordinator,
who is to provide a written justification for the waiver, and approval by the Executive Committee.
Revised 4/10/15 JO
Hawaii INBRE III – HiSREP
Summer 2015 Undergraduate Student Research Experiences (SRE)
Application (New)
Date
Name: Last, first, middle
Current Address: (street, apartment number, city, state, zip code)
Permanent Address: (street, apartment number, city, state, zip code)
Parent’s Address or alternate permanent contact address (if different from above):
Hometown and State:
Date of Birth:
Email:
Phone Number:
Alternate Non-UH Email:
Permanent Contact Phone Number:
What is your gender? (Double clicking on box will bring up Wingdings and you can insert a checked box)
 Female
 Male
 Other
What is your race/ethnicity (please check all that apply)?
 Alaska Native
Hispanic or Latino
 American Indian
 Cuban/Cuban-American
 Black or African American
 Mexican/Mexican American/Chicano(a)
 Portuguese
 Puerto Rican
 White or Caucasian
 Other Hispanic/Latino: ________________
Native Hawaiian or Other Pacific Islander
 Chamorro
 Hawaiian
 Samoan
 Other Pacific Islander: ________________
Asian
 Asian Indian
 Chinese
 Filipino
 Japanese
Revised 4/10/15 JO
Other
 Other: _____________________________
 Adopted (Don’t Know)
 Unknown
 Prefer Not to Answer
 Korean
 Vietnamese
 Other Asian: ________________________
Hawaii INBRE III – HiSREP
Summer 2015 Undergraduate Student Research Experiences (SRE)
Application (New)
What race/ethnicity do you primarily identify with (Please choose one of the above):
Which generation in your family was/will be the first to complete college?
 Prior to my Grandparents
 Parents
 Grandparents
 Sibling and/or me
Do you have a family member who has/had a career in the biomedical sciences or medical field?
 Yes
 No
What is your current completed educational level (check all that apply)?
 GED/High School Diploma
 Completed Bachelor’s Degree
 Completed Associate’s Degree
 Completed Master’s Degree
Educational institution currently attending:
Major and number of semesters completed:
If you are at a community college, are you pursuing an associate degree in Natural Sciences?
 Yes  No
If no, what degree are you pursuing?
Current cumulative GPA:
Did you participate in a previous INBRE Undergraduate Research Internship?
 Yes (please list year and term of most recent internship: ____________________________)
 No
What are your career interests? (Where do you see yourself working in 5-10 years?)
Revised 4/10/15 JO
Hawaii INBRE III – HiSREP
Summer 2015 Undergraduate Student Research Experiences (SRE)
Application (New)
Personal Statement (250 words): Please include a brief explanation as to why you want to participate in
this research experience as well as what your research interests and long-term career goals are. Please
describe how your interests and this experience will relate to biomedical research.
Revised 4/10/15 JO
Hawaii INBRE III – HiSREP
Summer 2015 Undergraduate Student Research Experiences (SRE)
Application (New)
Campus Coordinator:
Lab Supervisor:
Lab Supervisor’s email:
Location:
(Attach a Letter of Recommendation from the Lab Supervisor)
Signature of Campus Coordinator
Date Signed
X______________________________________________
I hereby agree to
the terms and
conditions of this
application.
Revised 4/10/15 JO
Signature of Applicant
X____________________________________________
Date Signed
Hawaii INBRE III – HiSREP
Summer 2015 Undergraduate Student Research Experiences (SRE)
Application (New)
Please give your hard copy application to the appropriate Campus Coordinator.
Institution
Campus Coordinator
Kapiolani Community College
Dr. John Berestecky: [email protected]
Dr. Matthew Tuthill: [email protected]
Windward Community College
Dr. Leticia Colmenares: [email protected]
Hawaii Community College
Dr. Susan Jarvi: [email protected]
Lisa Kaluna: [email protected]
Leeward Community College
Dr. Kabi Neupane: [email protected]
University of Hawaii Maui College
Dr. Sally Irwin: [email protected]
Dr. Sean Calder: [email protected]
Hawaii Pacific University
Dr. David Horgen: [email protected]
Kauai Community College
Dr. Sharad Marahatta: [email protected]
University of Hawaii Hilo
Dr. Susan Jarvi: [email protected]
Chaminade University
Dr. Helen Turner: [email protected]
University of Hawaii Manoa
Dr. David Haymer: [email protected]
Revised 4/10/15 JO