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1 Health Sciences Research Summer Program Summer 2017 The Emory-Children s Pediatric Center, Department of Medicine, and Department of Biomedical Engineering in partnership with Druid Hills High School bring forward a ten-week paid summer research opportunity. We are looking for highly motivated high school students who have taken at least one college-level science course (e.g., AP Biology, Honors Chemistry, etc.) and have at least a B average (3.0 on a 4.0 scale or the equivalent). We will give preference to students who will complete their junior or senior years in spring The program is supported by the Rhame Foundation and Woodruff Health Sciences Center. It is an extension of the NIH Funded Pediatric Engineering Research Summer Experience (PERSE). The opportunity is made possible due to the collaborative efforts of Emory University and Georgia Tech s Biomedical Engineering Department, the Department of Pediatrics within Emory University's School of Medicine, Emory College s Summer Undergraduate Research Program (SURE), and Children s Healthcare of Atlanta. It begins May 30 and concludes August 3, Scholars will be required to meet program mentors at the beginning of the program. Once the program begins, Scholars are required to be present for the entire ten-week program and may not be otherwise employed. The program primarily focuses on student engagement in mentored laboratory research projects. This research takes place at the Health Sciences Research Building and other select areas on campus. We will pay Scholars a stipend for their full-time commitment of 40 hrs/week during the ten-week program. Scholars are expected to provide their own transportation between their homes and the program sites on a daily basis as well as provide their own meals. Scholars must also provide immunization records, negative TB test results within the last six months and negative drug test results. Applicants must include signatures from one of your science teachers and submit two letters of recommendation from teachers, counselors or other community professionals (who are not related to you). Please postmark or your completed application by March 20, 2017; details are on the application. You also must submit an official, registrar-sealed transcript by this date. We will select from the applications candidates for interview before making offers of acceptance into the program. Please contact Barbara Walsh if you have questions. We look forward to receiving your application.

2 Student Application 2017 Health Sciences Research Summer Program Please type or neatly print your responses on this application. All materials must be postmarked or ed by March 20, Scholars selected for this program will be required to provide immunization records, negative TB test results within the last six months and negative drug test results. I. Personal Data: Name First Middle Last Date of Birth / / Please note: You must be 16 years or older by June 1, 2017, to participate in this program. Home Address City State ZIP Home Phone Cell Phone Address Sex/Gender Grade entering in Fall 2017 Race/Ethnicity: What race/ethnicity do you consider yourself to be? Select one or more of the following: American Indian or Alaska Native. A person having origins in any of the original peoples of the North, Central or South Americas, and who maintains tribal affiliation or community attachment. Asian or Asian American. A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands/Pacific Islanders, Thailand and Vietnam. African American or of African descent. A person having origins in any of the black racial groups of Africa. Hispanic or Latino. A person of Mexican, Puerto Rican, Cuban, South or Central American or other Spanish culture or origin, regardless of race. The term Spanish origin can be used in addition to Hispanic or Latino. Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands. White. A person having origins in any of the original peoples of Europe. Do you have any relatives who work at Emory or Georgia Tech? and relationship below. If yes, please provide names

3 II. Educational Information: Name and City of High School Address of High School Phone number of High School Projected Graduation Date Cumulative GPA (based on 4.0 scale) Provide scores for at least one of the following standardized tests: PSAT or SAT Score SAT Verbal: SAT Math: PSAT Verbal: PSAT Math: ACT Score Math: English: Science: Reading: Please list all Advanced Placement, honors or other college-level science courses you have completed (or expect to complete this year): III. Activities/Awards (You may attach a separate sheet if necessary): Are you a member of the Science National Honor Society? Name of SNHS Chapter Advisor Have you participated in any science-related special events, such as a brain bee, neuroscience expo or science Olympiad? If yes, please provide details: Name of Other Activities Description Dates

4 Honors and Awards (You may attach a separate sheet if necessary): Name of Honor/Award Description of Honor/Award Date IV. Other Do you have any former laboratory experience? If so, please describe the work, the location and the time frame. _ How did you learn about the Summer Research Program? V. Personal Statement In no more than 400 words, describe how a summer research experience will contribute to your educational and professional goals. Please type and double space your statement on a separate sheet of paper and attach it to this application. Please sign the page to indicate your authorship of the information. VI. Letters of Recommendation Please send two letters of recommendation with your application. One must be from a science teacher. The other may come from a teacher, counselor, community group leader, etc.), but must not be from anyone related to you. Be sure to have the recommenders sign the recommendations. They must also fill out evaluation form provided below. VII. Transcript Please send an official high school transcript. Your transcript may be mailed separately from your application. Be sure your transcript is postmarked by the March 20, 2017 application deadline. VIII. Certification My signature below affirms the information contained in this application is true and accurate to the best of my knowledge. I also affirm that I can arrange for my own transportation and meals, and am available to work full time every day for the duration of the program. I grant the program committee the use of my official school transcript when reviewing my application. Signature of Applicant Date

5 Signature of Science Teacher (required for all applicants) Date A parent or guardian must provide a short statement of support and sign that he or she has read the above statement and approves your application. Signature of Parent/Guardian) Date All materials must be postmarked or ed by March 20, Send your completed information to: To Principal Cunningham. We will collect the applications from her. Health Sciences Research Summer Program

6 Summer 2017 Applicant Name: Date of Birth: Respondent Information: Title: Family Education Rights & Privacy Act of 1974 In accordance with FERPA, this applicant has chosen to waive or not waive his/her right to review the recommendation. Acquaintance with the Applicant: 1) I have known the applicant for: 2) I have known the applicant as Student Research Assistant Volunteer Other: 3) I have served as the applicant s (select as many as are applicable): Advisor Teacher (one class) Teacher (many classes) Other: Scholarly Characteristics: 4) Overall Intellectual Ability: 5) Knowledge in Chosen Field: 6) Overall Scientific Ability: 7) Overall Imaginative/Creative Ability: 8) Motivation- Perseverance Commitment: 9) Verbal Communication in English: 10) Written Communication in English: 11) Visual/Graphic Communication in English: 12) Analytical Ability: 13) Initiative: 14) Ability to Work Independently: 15) Ability to Work as a Team Member: 16) Maturity and Stability: 17) Rank relative to others you know who have applied to the summer program: Overall Recommendation: 18) Overall Rating: Strongly Recommend Recommend Recommend with Reservations Do Not Recommend

7 19) Overall Ranking (Academic Recommendation Only): Best Student This Year Best Students in Year(s) Top % of Students This Year Unable to Rank

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