Welcome to the Vanderbilt University School of Medicine and to the Application Section for the Summer Research and Training Program.

Vanderbilt University School of Medicine, Division of Diabetes, Endocrinology and Metabolism, invites applications for the Medical Student Research Training Program in Diabetes, Endocrinology and Metabolic Diseases for the summer of 2008. This program is funded by the National Institutes of Health (Diabetes, and Digestive, and Kidney Diseases branch) and allows medical students during the summer between the first and second year or second and third year to conduct independent research under the direction of an established scientist. Prior research experience is not required.

Note: Because this is a federally-funded program, ALL PARTICIPANTS MUST BE EITHER A U.S. CITIZEN OR PERMANENT RESIDENT.

Application deadline for summer of 2008 is February 15, 2008.

Please complete all questions in the Student Application below and please read the following:

1. If you are NOT a Vanderbilt student, you will need to complete the Dean's Contact Information area of the Application. It is not necessary for Vanderbilt students to complete this area.
2. After submitting the application, you will be directed to print a copy of the application. Please sign this printed application and also have your Dean sign it.
3. Your signature certifies that all the information contained in your application is true. Your Dean's signature certifies that you are a student in good standing in your medical school.
4. Vanderbilt Students must deliver (DO NOT MAIL) your printed application signed by yourself and your Dean to:
   
   The Division of Diabetes, Endocrinology & Metabolism
   Administrative Office — 7465 MRB IV
   — OR — You may fax it to 615-936-1667.
5. NON-Vanderbilt Students must mail or fax your printed application signed by yourself and your Dean to:
   
   Student Research Training Program
   The Division of Diabetes, Endocrinology & Metabolism
   Vanderbilt University Medical Center
   7465 MRB IV
   2213 Garland Avenue
   Nashville, TN 37232-0475
   — OR — You may fax it to 615-936-1667.

Application fields marked with a * are required. If you wish to submit documents (e.g., a CV or letter of recommendation) to accompany your application, you may upload these via the "Upload Document" fields located at the end of the application. You have the option of submitting two documents.

Applications will be reviewed promptly and you should expect a letter of action taken within one month of the deadline. For questions, please phone (615) 936-1760 or email lisa.downs@vanderbilt.edu.

Please remember that you are expected to be present for 9-12 weeks at Vanderbilt and that you must be present on July 31 and August 1, 2008 for research presentations.

SRTP Student Application

* First Name:
Middle Initial:
* Last Name:
* Email Address:
** Biographical Information (Please see additional information about this section of the form.)
* Date of Birth: (mm/dd/yyyy)
* Social Security Number: (xxx-xx-xxxx)
Gender:	Male Female
Are you Hispanic (or Latino):	Yes No
** Race/ethnicity — please select one: (Please see additional information about this section of the form.)	American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander White
United States Citizen:	Yes No
If not a United States citizen, are you a permanent resident?	Yes No
* Medical School Name:
* Medical School Address: (street address):
Medical School Address 2:
* Medical School Class (freshman, sophomore, etc.):
Note: The following 3 fields each hold approximately 200 words. If your response exceeds that amount, you may instead wish to create your response in a MS Word document (or another program), and use the "Upload Document" files below this form to submit your document.
* Why are you interested in diabetes or diabetes-related research?
* Please describe any prior research experience:
* Please indicate your current thoughts about long-range career plans and goals:
Address Information
* Current Mailing Street Address:
Current Mailing Street Address Two:
Current Mailing Apartment Number:
* Current Mailing City:
* Current Mailing State:	Select from list below:    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
* Current Mailing Zip Code:
* Current Phone Number: (xxx-xxx-xxxx)
* Permanent Mailing Street Address:
Permanent Mailing Street Address Two:
Permanent Mailing Apartment Number:
* Permanent Mailing City:
* Permanent Mailing State:	Select from list below:    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
* Permanent Mailing Zip Code:
* Permanent Phone Number: (xxx-xxx-xxxx)
For Non-Vanderbilt Students only - please provide your dean's contact information in the form below:
Dean's First Name:
Dean's Middle Initial:
Dean's Last Name
Title:
Address One:
Dean's Address Two:
Dean's City:
Dean's State:	Select from list below:    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Phone: (xxx-xxx-xxxx)
Fax: (xxx-xxx-xxxx)
Email:
You may choose to upload a recommendation letter or any other document that you wish to associate with your application (max of two document files):
Upload Document:
Upload Document:

The Medical Student Summer Research Training Program is supported by the Vanderbilt Short Term Research Training Program for Medical Students (NIH grant DK007383) and the Vanderbilt Diabetes Research and Training Center (NIH grant DK20593).