CEEZAD BSL-3/Transboundary Animal Disease Summer Program Application
Applicant name: __________________________________
Date: _____________________
I. Background and Contact Information
Applicant
Name (last, first, middle):
Mentor (if applicable)
Name (last, first, middle):
Address:
Address:
Email:
Email:
Date of birth:
Primary department:
Place of birth:
College/ University:
Student ID number:
Phone :
The contact information above will be used to communicate with you during application processing and review.
If any contact information changes, you must notify us in writing via e-mail or postal mail.
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Summer 2015
CEEZAD BSL-3/Transboundary Animal Disease Summer Program Application
Applicant name: __________________________________
Date: _____________________
II. Education
1. High School: Please include additional high schools attended in an attached Word file.
High School
City, State, Country
Graduation Date
Cumulative
GPA
If your GPA is on a scale other than 0-4, please explain:
2. Undergraduate: This includes all Technical Schools, Community Colleges, and Universities/Colleges you
have attended. Transcripts from each institution must be submitted with the application. Please include any
additional undergraduate schools attended in an attached Word file.
University/College
(City, State, Country)
Dates of
Attendance
(mm/yyyy) –
(mm/yyyy)
Major Field of Study
Degree
Received
Date Degree
Received
(mm/yyyy)
Cumulative
GPA
3. Graduate: Transcripts from each institution must be submitted with the application.
Please include any additional graduate schools attended in an attached Word file.
University/College
(City, State, Country)
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Dates of
Attendance
(mm/yyyy) –
(mm/yyyy)
Major Field of Study
Degree
Received
or
Expected
Date Degree
Received or
Expected
(mm/yyyy)
Cumulative
GPA
Summer 2015
CEEZAD BSL-3/Transboundary Animal Disease Summer Program Application
Applicant name: __________________________________
Date: _____________________
III. Work Experience
Paid or volunteer employment. Please include any additional experiences in an attached Word file.
Organization/Employer
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Dates of
service
(mm/yyyy) –
(mm/yyyy)
Paid/
Voluntary
Description of duties (5 sentences or less)
Summer 2015
CEEZAD BSL-3/Transboundary Animal Disease Summer Program Application
Applicant name: __________________________________
Date: _____________________
IV. Research Experience
Beginning with the most recent. Please include any additional experiences in an attached Word file.
Position
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Dates
(mm/yyyy) –
(mm/yyyy)
Description of research (5 sentences or less)
Summer 2015
CEEZAD BSL-3/Transboundary Animal Disease Summer Program Application
Applicant name: __________________________________
Date: _____________________
V. Academic Awards and Honors
Please include any additional awards/honors, memberships and/or publications in an attached Word file.
1. List any awards/honors, (including fellowships) you have received:
2. List any student or professional memberships (include years):
3. List any publications (peer-reviewed, presentations, posters):
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Summer 2015
CEEZAD BSL-3/Transboundary Animal Disease Summer Program Application
Applicant name: __________________________________
Date: _____________________
VI. Statement of Educational and Professional Goals.
Please provide an essay describing your educational and professional goals. How will participation in this
program benefit your career goals?
Use Arial 11 pt. font and limit your response to one page maximum.
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Summer 2015
CEEZAD BSL-3/Transboundary Animal Disease Summer Program Application
Applicant name: __________________________________
Date: _____________________
VII. References
List at least two people familiar with your academic preparation and your technical abilities. Please provide
each of these individuals the necessary information to submit a reference on your behalf electronically.
Relatives should not be asked to submit a reference.
Name
Title and Organization
1.
2.
VIII. Transcripts/GRE Scores
Please send the following documents with your application:
1. Grade transcripts (undergraduate and graduate). “Unofficial” scan of official document is sufficient.
2. GRE scores. “Unofficial” scan of official document is sufficient.
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Summer 2015