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:
Last
First
Date of Birth: (mm/dd/yyyy) Gender:   Male    Female
Citizenship Status: US Citizen
Perm Resident   		  
Place of Birth (city, state, country)
Visa Number
Hometown Info:
(i.e., where you graduated from high school)
City
State or US Territory
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)    Native American(specify tribal affiliation below)    Other (specify below)  
Ethnicity Specify:

Contact Information

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

Academic Information

UCB Genentech? Yes   No   (Genentech application deadline is March 2, 2009)
Current Undergrad Institution:
(Spell out your institution and campus; for example: University of California, Berkeley)
Major: Status:
Expected Graduation Month: Year:
Expected Degree :    
Cumulative GPA:
(Do not round GPA)		 Major GPA :
(Do not round GPA)
Academic Honors or Awards:

Career Objective Information

Advanced Degree Objective :  
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
Briefly summarize your educational and long-term career goals (1-2 lines):

Other Summer Program Info

List other summer programs you are applying to:
Are you applying to other Amgen Scholars Programs? Yes   No
If so, please list the name(s) here:   
Have you participated in an Amgen Scholars Program in the past? Yes   No
If so, please list the name here:   
[Note: If you have participated in another Amgen Scholars Program you are Not Eligible to participate again.]

Research Experience

Do you have research experience? Yes   No   (Please do not list any pre-college research experience)
If you have participated in any undergraduate research program(s), check the appropriate box(es):
MARC   MBRS   COR   Howard Hughes   UC LEADS   McNair   Other
List all current and previous research experiences:
1) Program Name: Dates of Participation:
  University/Agency/Biotech Company:
  Term: Academic Year    Summer
2) Program Name: Dates of Participation:
  University/Agency/Biotech Company:
  Term: Academic Year    Summer
3) Program Name: Dates of Participation:
  University/Agency/Biotech Company:
  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
(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, reason for applying to the Amgen Scholars Summer Program, how your participation in the program may assist in meeting your future educational, career, and professional goals, and state your specific research interest during the summer. (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)  
 SACNAS  
 ABRCMS  
 Other Conference (indicate below)  
 Internet Search  
 E-mail announcement  
 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 : All applicants are required to submit two letters of recommendation. Please provide this Interactive PDF form to your recommenders to submit along with their letter of recommendation. Free Adobe Acrobat Reader.

Interactive Recommendation Form (PDF)

College/University Transcripts: Please submit a college/university transcript from all schools attended. Unofficial transcripts are acceptable. Please send letters and transcript(s) to:

Amgen Scholars Program
158 Barrows Hall, MC# 2990
University of California, Berkeley
Berkeley, CA 94720-2990
510-642-5113
510-642-0280

Copyright © 2007 UC Regents. All rights reserved.