First name:
* must provide value
Provide your legal name as it appears on official or government-issued documents (passports, licenses etc.)
If applicable.
Last name:
* must provide value
Provide your legal name as it appears on official or government-issued documents (passports, licenses etc.)
If applicable.
Date of birth (MM-DD-YYYY):
* must provide value
Today M-D-Y *According to RPCI policy, persons under the age of 14 years old are not allowed to train in a research laboratory
Citizenship:
* must provide value
U.S. citizen
Permanent resident
Foreign
Place of residency:
* must provide value
United States
Commonwealth of Puerto Rico
Northern Mariana Islands
Guam
American Samoa
Trust Territory of the Pacific
Current enrollment:
* must provide value
High School
College/University
Dental School
Medical School
PA School
Current grade level:
* must provide value
Freshman
Sophmore
Sophomore enrolled in the Honors Program
Junior
Senior
Graduated
Home/landline phone number:
* must provide value
Personal/cell phone number:
* must provide value
If you do not own a cell phone, list your home phone again here.
School/work/daytime phone number:
If different from personal phone number.
Personal/permanent email address:
* must provide value
School email address:
* must provide value
Mailing/Campus housing address: Dormitory or Housing Complex
If applicable.
Mailing/Campus housing address: Number and Street
* must provide value
Mailing/Campus housing address: City/Town
* must provide value
Mailing/Campus housing address: State
* must provide value
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam 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 Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Mailing/Campus housing address: ZIP code
* must provide value
Address: Number and Street
* must provide value
Address: City/Town
* must provide value
Address: State
* must provide value
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam 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 Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Address: ZIP code
* must provide value
The following demographic information is requested on voluntary basis. It is being collected for purposes of tracking demographics of the applicant pool ONLY and is NOT considered in the review of applications.
African American
American Indian or Alaskan Native
Asian (originating from Far East Asia, South East Asia, Indian Subcontinent)
Pacific Islander (including Fijian, Hawaiian, Samoan)
Latino (including Mexican American; not Puerto Rican)
Puerto Rican
White, Anglo, Caucasian American (non-Hispanic)
Male
Female
Are you the first generation in your family to attend college?
Yes
No
Highest level of education anyone in your immediate family attended
High school
Two-year community college
Four-year undergraduate
Graduate school (including medical school)
Highest degree level obtained by anyone in your immediate family
High School Diploma
Associate's Degree
Bachelor's Degree
Master's
Doctoral (ie MD, PhD, etc.)
Is anyone in your immediate family in a scientific or health-related profession?
Yes
No
Name of college or university:
* must provide value
If applicable.
College address: City/Town
* must provide value
College address: State
* must provide value
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam 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 Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Anticipated graduation date (MM/DD/YYYY):
* must provide value
Today M-D-Y
Current degree sought:
* must provide value
BA
BS
Other
Other degree:
* must provide value
Major:
* must provide value
Special Program (i.e. Honors):
If applicable.
Cumulative OVERALL GPA:
* must provide value
Round to two decimal places. Include grades from most recent completed semester.
Cumulative SCIENCE GPA:
* must provide value
Round to two decimal places. Include grades from most recent completed semester.
What scale is used to determine your GPA?
* must provide value
4.0
3.0
100%
Other
Other Scale:
* must provide value
Does your school rank students based on overall GPA?
* must provide value
Yes
No
Your class rank:
* must provide value
Enter numerical value.
Indicate if this is a "rank" or "percentile":
* must provide value
Percentile Rank
Number of students in your class:
* must provide value
Enter numerical value.
Select courses or course equivalents you have already completed or those you will be taking in the upcoming Spring semester.
* must provide value
Other course:
* must provide value
Enter score if applicable.
Enter score if applicable.
Enter score if applicable.
Life Science MCAT/DAT score:
Enter score if applicable.
Physical Science MCAT/DAT score:
Enter score if applicable.
List SCIENCE-related co-curricular activities in which you participate(d) by category below. For multiple items in a field (i.e. more than one award) name each in most recent chronological order and separate by a comma. If none, type "None."
Awards and achievements:
* must provide value
Type "None" if there are none.
Society and club memberships:
* must provide value
Type "None" if there are none.
Officer/leadership positions:
* must provide value
Type "None" if there are none.
Select any of the following special academic programs in which you are currently enrolled:
Other program:
* must provide value
Provide information below about the academic program that you selected in the previous question.
Does your program provide a stipend for externships?
* must provide value
Yes
No
Name of institution:
* must provide value
Name of program coordinator:
* must provide value
Coordinator's email address:
* must provide value
Coordinator's phone number:
* must provide value
Allotted stipend:
* must provide value
Enter numerical value, if none, enter '0'
Duration of time funded by stipend (in weeks):
* must provide value
Enter numerical value, if none, enter '0'
URL to program website:
* must provide value
Are laboratory research facilities and mentorship readily available at your school or college?
* must provide value
Yes
No
Have you participated in previous research internships or have prior research experience?
* must provide value
Yes
No
Select the type(s) of research experience(s) in which you participated:
Other type of research experience:
* must provide value
Provide the information below about your MOST RECENT research experience:
Project Title/topic:
* must provide value
Research supervisor:
* must provide value
Site of experience:
* must provide value
Name of institution or university
Site of experience: Department
* must provide value
If applicable.
Have you given scientific talks or presentations?
* must provide value
Yes
No
Type(s) of presentation(s) given:
* must provide value
You may select more than one.
Provide the following information about your MOST RECENT scientific talk/presentation.
Presentation title/topic:
* must provide value
Site of talk/presentation:
* must provide value
Institution, university or conference name
Site of talk: City
* must provide value
Site of talk: State
* must provide value
Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam 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 Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Year of talk:
* must provide value
Select the statement that best describes your educational goal after college:
* must provide value
Take time off
Apply to MS program
Apply to PhD program
Apply to combined PhD/MD program
Apply to Medical/DO school
Apply to MPH program
Apply to PA school
Undecided
Other
Other goal:
* must provide value
Select the statement below that best describes your current career goals:
* must provide value
I am unsure of my future career goals.
I am interested in pursuing a medical/allied health profession.
I am interested in pursuing a scientific profession.
I am interested in pursuing a profession specializing in cancer.
I am interested in pursuing a medical/allied health profession specializing in oncology.
I am interested in pursuing a scientific profession specializing in cancer research.
I am interested in pursuing a combined medical and scientific profession.
I am interested in pursuing a combined medical and scientific profession specializing in oncology/cancer research.
Based on the education and career goals you have selected, write a personal statement which answers the following three questions in paragraph form (LIMIT TO 300 WORDS):(1) What is your motivation towards the educational and career goals you have chosen?(2) How will an internship in a cancer research laboratory help you to determine or achieve your education and career goals.(3) What knowledge, skills and insight do you hope to attain from a cancer research experience?
LIMIT TO 300 WORDS
Mentor Directory- Review Mentor profiles by downloading the attached file.
First choice mentor:
* must provide value
Abel, Ethan Buxbaum, Nataliya Chandra, Dhyan Goniewicz, Maciej Li, Fengzhi Shafirstein, Gal Singh, Anurag Zhang, Jianmin
Second choice mentor:
* must provide value
Abel, Ethan Buxbaum, Nataliya Chandra, Dhyan Goniewicz, Maciej Ling, Xiang Shafirstein, Gal Singh, Anurag Zhang, Jianmin
Third choice mentor:
* must provide value
Abel, Ethan Buxbaum, Nataliya Chandra, Dhyan Goniewicz, Maciej Ling, Xiang Shafirstein, Gal Singh, Anurag Zhang, Jianmin
Fourth choice mentor:
* must provide value
Abel, Ethan Buxbaum, Nataliya Chandra, Dhyan Goniewicz, Maciej Ling, Xiang Shafirstein, Gal Singh, Anurag Zhang, Jianmin
Provide the following contact information for one reference. This should be an individual who can assess your science abilities, for example: a science professor, research supervisor or advisor. Be sure to request permission from the individual to serve as a reference. An email containing a link to an on-line recommendation form will be sent to each of your references to complete on your behalf. To ensure timely receipt of the form: (1) be sure that the contact information you provide for your references is accurate and (2) inform each reference that they should add the "roswellpark.org" domain to their safe-list in their email account so that it is not spam-filtered.
First name:
* must provide value
Last name
* must provide value
Academic/employment title
* must provide value
Place of employment
* must provide value
School/official email address
* must provide value
School/office phone number
* must provide value
First name
* must provide value
Last name
* must provide value
Academic/employment title
* must provide value
Place of employment
* must provide value
School/official email address
* must provide value
School/office phone number
* must provide value
How did you learn about the program?
* must provide value
If you are accepted into the program and your permanent residence is outside commuting distance to Buffalo NY, will you be requiring short-term housing.
* must provide value
Yes
No
Laboratory Coat Size:
* must provide value
2X-Small X-Small Small Medium Large X-Large 2X-Large
Accepted students receive a program monogrammed laboratory coat on loan for the summer.
Answer the following question regarding your application:
* must provide value
I authorize every school that I have attended to release all requested records and recommendations to Roswell Park Cancer Institute for the purpose of evaluating my application to the summer educational program. I also authorize employees of Roswell Park Cancer Institute to contact, in confidence, my current and former schools should they have questions about the information submitted on my behalf.
Answer the following question to waive the right to review your recommendation and supporting application materials (This is done to assure candid responses from y our recommenders)
* must provide value
I waive my right to review all recommendations and supporting documents submitted by me or on my behalf as part of the application to the summer educational program. I understand that I will not be able to access these recommendations through Roswell Park Cancer Institute or through my current school.
Please read the following regarding COVID-19 vaccination requirement for participating in research activities on Roswell Park's campus:
I acknowledge that should I be admitted to the Howard University/Roswell Park Cancer Scholars Program I will be required to show proof of a COVID-19 vaccination.
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