• A cover letter describing your future academic plans, interests in biomedical sciences and reasons for seeking a summer internship.
• Two letters of recommendation from school officials (e.g. high school science teachers, college science faculty, previous science preceptors, etc.) who have direct knowledge of your scientific interests and abilities. Each letter should be in a sealed envelope, signed by the author on the back flap.
• A self addressed stamped postcard for acknowledgment of receipt of application.
• All application materials should be submitted in a single envelope. This is essential in order to expedite the application review process.
• Graduating college seniors who are selected for this program, if possible, should provide evidence of acceptance to an accredited institution at the next educational level, (e.g. acceptance letter to graduate or professional school, etc.). Please submit to the appropriate summer research coordinator by the time internships are finalized in the spring.
• All students selected for this program are required to provide acceptable proof of U.S. citizenship or residency status. For U.S. citizens, proof may be documented by submitting a copy of your birth certificate or passport. Permanent residents will need to provide a copy of your alien registration card number.
• Transcripts from all colleges listed on the application need to be sent to this office.

SANSUM DIABETES RESEARCH INSTITUTE
2219 Bath Street
Santa Barbara, CA 93105
Phone: 805-682-7638
Fax: 805-682-3332

SUMMER INTERNSHIP PROGRAM
APPLICATION FORM

CURRENT MAILING ADDRESS _____________________________________________________

TELEPHONE ___________________________________________________________________

FAX _________________________________________________________________________

EMAIL _______________________________________________________________________

DATE GRADUATED FROM HIGH SCHOOL ____________________________________________

SOCIAL SECURITY NUMBER ______________________ BIRTHDATE ______________________

COLLEGE(S) ATTENDED W/ADDRESS FROM - TO (mo/yr)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

COLLEGE CURRENTLY ATTENDING: _________________________________________________

MAJOR: _______________________________________________________________________

MINOR: _______________________________________________________________________

ANTICIPATED GRADUATION DATE: _________________________________________________

ACADEMIC STATUS THIS FALL:_____________________________________________________

FULL TIME STUDENT? ____________________________________________________________

COURSES ENROLLED IN THIS SEMESTER/QUARTER: Units

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

YOUR OVERALL GPA: ______________ SCIENCE/MATH GPA: ____________________________

1. Have you applied to this program previously? YES ( ) NO ( )
   
2. How did you learn about this program?
   
3. Have you done research or independent study previously? YES ( ) NO ( )
   If YES, please describe:
   
   
4. What have been your work experiences?
   
   
5. Are there any special circumstances (ethnic, financial, physical or social etc.) that you believe
   require consideration?
   
   
6. What are your honors, and special interests?
   
   
7. What are your thoughts about:
   

A research career?

A clinical career?

A basic science career?

TELL THE STUDENT INTERNSHIP SUBCOMMITTEE ABOUT YOURSELF.

Why did you decide to apply to this program? How will it help you and your career choice? (Limit your answer to this page.)

I certify that the information provided in this application is correct.

_______________________________________________ Date : ____________________________________

Applicant's Signature



FOR SCREENING PURPOSES ONLY. Please list the course work in the following areas that you have completed, or will have completed by June.