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High School Summer Research Experience Program in Cancer Science Online Application

Returning?

A A A

INSTRUCTIONS:
This is the application for high school students. It is recommended that you have the following documents and resources available to reference when completing your application:
1. A prepared personal statement based on the sample provided at the instructions page.
2. The Internship Directory containing the list of available summer mentors and their research projects.
3. A transcript or academic record.
4. A CV/resume.

SAVING PROGRESS: You can save your progress on the application and complete later by clicking the "Save & Submit Later" button located at the very bottom of the application. Be sure to save your personal code to re-enter the application later.

First name:

* must provide value

Middle name:

Last name:

* must provide value

Suffix, if any:

Date of birth (MM-DD-YYYY):

* must provide value

M-D-Y

Citizenship:

* must provide value

U.S. citizen

Permanent resident

Foreign

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Place of residency:

* must provide value

United States

Commonwealth of Puerto Rico

Northern Mariana Islands

Guam

American Samoa

Trust Territory of the Pacific

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Current enrollment:

* must provide value

High School

College/University

Dental School

Medical School

PA School

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Current grade level:

* must provide value

Freshman

Sophmore

Junior

Senior

Graduated

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IMPORTANT: You are being asked to provide the following contact information for yourself and a parent/guardian (where indicated) who will sign program documents and permission forms. Be sure to include area codes with phone numbers. This information will be used to conduct correspondence during the applicatioon process.

Home/landline phone number:

* must provide value

Landline or cell phone number:

* must provide value

Personal/permanent email address:

* must provide value

School email address:

Residential address: Number and Street

* must provide value

Residential address: City/Town

* must provide value

Residential address: State

* must provide value

Residential County:

Chautauqua

Erie

Genesee

Niagara

Orleans

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Residential address: ZIP code

* must provide value

Mailing address: Apartment or Housing Complex

Mailing address: Number and Street

Mailing address: City/Town

Mailing address: State

Mailing address: ZIP code

Parent/Guardian First Name:

* must provide value

Parent/Guardian Last Name:

* must provide value

Parent/guardian email address:

* must provide value

Parent/guardian daytime phone:

* must provide value

Parent/Guardian address: Number and Street

Parent/Guardian address: City/Town

* must provide value

Parent/Guardian address: State

* must provide value

Parent/Guardian address: ZIP code

* must provide value

Funding sources may be available to support research experiences for applicants based on their eligibility of being from an under-represented minority, economically disadvantaged or having a family member with cancer. If you believe you qualify in one or both of these categories, answer the questions in this section to apply to these funding sources. IT IS IMPORTANT TO NOTE: Acceptance into this program and the award of a stipend is based on the merits of your application. The potential source of your stipend funding is based on how you answer the questions in this section.

Race:

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)

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Are you enrolled in the National School Lunch Program to receive free or reduced lunches?

Yes

Do you have an immediate family member (brother, sister, mother, father) with breast cancer?

I don't have an immediate family member with breast cancer.

I have an immediate family member who is a current breast cancer patient.

I have an immediate family member who is a breast cancer survivor.

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The following demographic information is requested on a 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.

Gender at birth:

Male

Female

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Gender identity:

Are you the first generation in your family to attend college?

Yes

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Is anyone in your immediate family in a scientific or health-related profession?

Yes

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Highest level of education anyone in your immediate family attended

High School

Two-year community college

Four-year undergraduate

Graduate school (including medical school)

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Highest degree level obtained by anyone in your immediate family

None

High School diploma

Associate's degree

Bachelor's degree

Master's degree

Doctoral degree (ie MD, PhD, etc.)

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Name of high school:

* must provide value

High school address: City/Town

* must provide value

High school address: State

* must provide value

Anticipated graduation date (MM/DD/YYYY):

* must provide value

M-D-Y

Special Program (i.e. Honors):

Cumulative OVERALL average:

* must provide value

Cumulative SCIENCE average:

* must provide value

What scale is used to determine your grade average?

* must provide value

4.0

3.0

100%

Other

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Other Scale:

* must provide value

Select courses or course equivalents you have already completed or those you will be taking in the upcoming Spring semester.

* must provide value

AP Biology

AP Chemistry

AP Physics

Biology I

Chemistry

Physics

Other

Other course:

* must provide value

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

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Society and club memberships:

* must provide value

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Officer/leadership positions:

* must provide value

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Are you currently enrolled in a specialized curriculum, academy or scholarship program at your high school? (ex. Life Sciences Academy)

* must provide value

Yes

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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

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Name of program:

* must provide value

Name of sponsoring 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

Duration of time funded by stipend (in weeks):

* must provide value

URL to program website:

* must provide value

Have you participated in previous research internships or have prior research experience?

* must provide value

Yes

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Select the type(s) of research experience(s) in which you participated:

* must provide value

Extramural high school internship

Extramural high school internship at Roswell Park (non-summer program)

City Honors/Roswell Park Research Program

Other

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

Site of experience:Department

Site of experience: City/Town

* must provide value

Site of experience: State

* must provide value

Have you participated in science fairs?

* must provide value

Yes

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Level(s) of science fair(s) at which you competed:

* must provide value

School/district

Local/regional

National/international

Select the science fairs at which you competed:

* must provide value

Intel International Science and Engineering Fair (ISEF)

Ying Tri-Region Science and Engineering Fair

Western New York Science Congress/WNY Science adn Engineering Fair

Other

Other science fair:

* must provide value

Total number of YEARS in which you participated in science fairs?

* must provide value

Most RECENT Science Fair title/topic:

* must provide value

Select the statement 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.

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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 career goals?

(3) What knowledge, skills and insight do you hope to attain from a cancer research experience?

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Choose two areas of cancer research that are of interest to you:

* must provide value

Cancer bioinformatics

Cancer biostatistics

Cancer biophysics

Cancer experimental diagnostics

Cancer genetics

Cancer molecular and cellular biology

Cancer molecular epidemiology

Cancer pharmacology and therapeutics

Cancer prevention and epidemiology

Tumor immunology & immunotherapy

First choice mentor:

* must provide value

Second choice mentor:

* must provide value

Third choice mentor:

* must provide value

Fourth choice mentor:

* 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

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

Graduate school/internship recruitment fair

Internet search

Parent/guardian

Presentation by Roswell Park representative (faculty member, graduate student, etc.)

Program flyer posting at school

Program posting at internship website (other than www.roswellpark.edu)

Roswell Park employee

Roswell Park summer program alumnus

Roswell Park summer program alumnus presenting their story formally as part of "Life Recorded, Life Rewarded" presentation at your school

Scientific presentation by previous summer program intern

Science professor at your school

Other

Select the channel of information that was the MOST influential on your decision to apply to the program:

* must provide value

Graduate school/internship recruitment fair

Internet search

Parent/guardian

Presentation by Roswell Park representative (faculty member, graduate student, etc.)

Program flyer posting at school

Program posting at internship website (other than www.roswellpark.edu)

Roswell Park employee

Roswell Park summer program alumnus

Roswell Park summer program alumnus presenting their story formally as part of "Life Recorded, Life Rewarded" presentation at your school

Scientific presentation by previous summer program intern

Science professor at your school

Other

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Other (describe):

If you are accepted into the program and your permanent residence is outside commuting distance to Buffalo NY, will you be staying at the program-sanctioned dormitory housing at Canisius College for the summer internship? (Lodging is at expense to the intern, except if awarded NIH CURE funding support.)

* must provide value

Yes

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Laboratory Coat Size:

* must provide value

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.