HHMI Summer Programs : Application Form
June 22- 28, 2008

Application Due Date: OPEN
Review of applications will begin on March 31, 2008 and will continue until the program is filled.

After completing this form and submitting please send a copy of your high school transcript to:

Dr. Regina Stevens-Truss
Director of the Arts and Science of Medicine Program
Kalamazoo College
1200 Academy St.
Kalamazoo, MI 49006

Personal Information
Your legal name	Last   First    Middle
Street Address
City, State, Zip
Area Code/Phone Number
Sex (optional)	Male   Female
Email
How would you describe yourself?	African American or Black    Asian or Pacific Islander    Multiracial   Hispanic or Latino    Native American or Alaskan Native    White
Mother's (or Guardian's) Full Name
Mother's address and telephone number, if different from yours
Father's (or Guardian's) Full Name
Father's address and telephone number, if different from yours
Academic Information
Your High School
Your school counselor's name	Form given to counselor? Yes No Date:
Name of teacher writing recommendation for you	Form given to teacher? Yes No Date:
Interests
Future career interest
This is a 1-week residential science workshop that is intended for high school students who are planning on pursuing careers in medicine. It includes classroom work 50% of the time and fieldwork the other 50%. If accepted you are required to stay the full length of the program at Kalamazoo College
In 5 to 10 sentences, please state why you want to participate in this summer program including your future career plans.
Verification Code	Enter the verification code as it is shown to the left. If you cannot read the code refresh your browser to try a different one.