UCB Amgen Scholars Program

Amgen Scholars Program Application

An Undergraduate Summer Research Program in Science and Biotechnology
at the University of California, Berkeley

Application

Letters of Recommendation

Contact Information

Student Information

Name:
First
Last
Middle Initial
Date of Birth: (mm/dd/yyyy)
Gender:   Male    Female
 
Citizenship Status: US Citizen
Perm Resident   
Visa Number		  
Place of Birth (city, state, country)
 
Hometown Information:
(i.e., where you graduated from high school)
City
State, Territory, etc.
Zip Code
 
Ethnicity:
check all that apply)		  African American    Caucasian    Chicano/Mexican American/Latino    Filipino    Puerto Rican    Asian American (specify below)    Pacific Islander (specify below)    East Indian    Middle Eastern (specify below)    Native American (specify tribal affiliation below)    Other (specify below)  
Ethnicity Specify:

Contact Information

Email Address:
Alternate Email Address:
  
Current Mailing Address:
Address Line 1:
Address Line 2:
City:
State/Territory:
Zip Code:
  
Permanent Address:
Address Line 1:
Address Line 2:
City:
State/Territory:
Zip Code:
  
Cell Phone: 555-555-5555
Lab Phone: 555-555-5555
Alternate Phone: 555-555-5555

Academic Information

Current Undergraduate Institution:
(Spell out your institution and campus; for example: University of California, Berkeley)
Start Date: Month:      Year: 
Major:
Status:
Expected Graduation: Month:      Year:
Expected Degree:
Cumulative GPA:    (Do not round GPA)
Major GPA :    (Do not round GPA)
Academic Honors or Awards:
For UCB students only: Are you also applying to the Genentech Scholars Program? Yes   No
(Note: Genentech application deadline is March 1, 2010)

Career Objective Information

Advanced Degree Objective :     Other Degree:
List the top three schools you plan to apply to for your advanced degree:
(Spell out the institution and campus)
1.
2.
3.
Which standardized test(s) have you taken or do you plan to take?
GRE MCAT Other
Do you plan to take the MCAT between May 31 and August 6, 2010?
Yes   No
Briefly summarize your educational and long-term career goals (1-2 lines):

Other Summer Program Information

Are you applying to other Amgen Scholars Programs? Yes   No
If so, please indicate which other Amgen sites you are applying to: (check all that apply)
 California Institute of Technology  
 Columbia University/Barnard College  
 Howard University  
 Massachusetts Institute of Technology  
 Stanford University  
 University of California, Los Angeles  
 University of California, San Diego  
 University of California, San Francisco  
 University of Washington  
List other summer programs you are applying to:
Have you participated in an Amgen Scholars Program in the past? Yes   No
If so, please indicate the name here:   
[Note: If you have participated in another Amgen Scholars Program you are ineligible to participate again.]

Research Experience

Are you currently working in a lab? Yes   No
Do you have research experience? Yes   No   
Please indicate if you have participated in any of the following undergraduate research program(s):
MARC   McNair   MBRS   AGEP   RISE   REU   Howard Hughes   UC LEADS   Other:
List all current and previous research experiences:
(Do not include any high school or pre-college research experience)
1) Research Position:
     Reseach Location:
     Start Date: Month       Year
     End Date: Month       Year
     Term: Academic Year    Summer
2) Research Position:
     Research Location:
     Start Date: Month        Year
     End Date: Month        Year
     Term: Academic Year    Summer
3) Research Position:
     Research Location:
     Start Date: Month        Year
     End Date: Month        Year
     Term: Academic Year    Summer

Research Preferences

Please indicate your preferred research areas of interest in the Amgen Scholars Summer Program:
For information about these areas see the Research Area Descriptions.
1st Choice: 2nd Choice:
3rd Choice: 4th Choice:
Research Area Other:

UC Berkeley Faculty Lab Placement Preferences
Note: This section MUST be completed!
(UCB applicants have the option of staying in their current lab or selecting a different lab)

Identify three UCB faculty members you are interested in working with during the summer.
Placement with a specific faculty member cannot be guaranteed.
1st Choice Faculty Name: Department:
2nd Choice Faculty Name: Department:
3rd Choice Faculty Name: Department:

Statement of Purpose

Describe in detail your previous research experience, state your specific research interest during the summer, and describe your future educational and career objectives. (Two page singled-spaced limit)

How did you learn about the Amgen Scholars Program? (check all that apply)

 Amgen National Website  
 UC Berkeley Amgen Website  
 Other university/college website (indicate below)  
 Internet Search  
 UCB Office of Undergraduate Research Website  
 Email Announcement  
 SACNAS Conference  
 ABRCMS Conference  
 Other Conference (indicate below)  
 UCB Amgen Brochure  
 Amgen Poster/Flyer  
 Academic Advisor  
 Faculty/Staff from your home university/college  
 Faculty/Staff at UC Berkeley  
 Faculty/Staff from other university (indicate below)  
 Other UC Berkeley Summer Programs  
 Other (indicate below)  

Other or Details:   

Supporting Documents

Letters of Recommendation:

College/University Transcripts:

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