The code block below illustrates how one might use # and // as comments in your logic and calculations.

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This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

BHE 2023

Returning?

A A A

Please complete the application below to be considered for the Buffalo Healthcare Exploration program taking place this Summer 2023.

Thank you!

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

Last Name

* must provide value

Date of Birth

* must provide value

M-D-Y

Citizenship

* must provide value

U.S. Citizen

Permanent Resident

International

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Current Grade

* must provide value

Have You Previously Applied to BHE?

* must provide value

Yes

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Were you accepted to the program? (Students who have already completed the entire program once are not eligible to apply again.)

* must provide value

Yes

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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 application process.

Personal/Cell Phone Number

* must provide value

Home Phone Number

Personal Email

* must provide value

Retype Personal Email

* must provide value

School Email Address

Permanent Residence: Street and Number

* must provide value

Permanent Residence: City

* must provide value

Permanent Residence: State

* must provide value

Permanent Residence: Zip Code

* must provide value

Parent/Guardian First Name

* must provide value

Parent/Guardian Last Name:

* must provide value

Parent/Guardian Phone Number

* must provide value

Parent/Guardian Email

* must provide value

Funding sources may be available that target certain populations of applicants based on being an under-represented minority or economically disadvantaged. If you believe you qualify in one or both of these categories, answer the questions in this section to apply to the available scholarships.
IT IS IMPORTANT TO NOTE: Acceptance into this program is based on the merits of your application. The potential source of your scholarship funding is based on how you answer the questions in this section.

Race/Ethnicity:

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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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

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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School Name

* must provide value

School Address: City/Town

* must provide value

School Address: State

* must provide value

Current Cumulative GPA

* 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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Do you have a computer that you can use during this summer program?

* must provide value

Yes

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What virtual learning platforms have you used before and will be able to use this summer? Mark all that apply.

* must provide value

Google Classroom

Zoom

WebEx

Microsoft Teams

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

Select any of the STEM or after school enrichment programs in which you currently participate:

Buffalo Prep

UB STEP

UB Medical STEP

P-TECH

Other

Please specify

* must provide value

Do you have any food allergies or requests?

* must provide value

Yes

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Please specify.

* must provide value

Do you have any communication, mobility, learning, or other potential barriers to your success that we should know in order to make this program safe and accessible for you?

*Note: Nothing you write will affect our assessment of your eligibility to participate in the program. Your answer will not be seen by anyone but the program chair and coordinators. Participants are selected solely based on their application (essay questions, CV, etc).

* must provide value

Yes

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Please specify.

* must provide value

Would you like to request financial aid?

*Note: We are able to fully fund accepted students who request financial aid. Your request will not affect our assessment of application.

* must provide value

Yes

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I am enrolled in the National School Lunch Program to receive free or reduced rate lunches.

* Note: Documentation will be checked at the start of the program

Yes

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Why are you interested in this program? How will it contribute to your long-term goals?
(Please use complete sentences with a minimum of 2 paragraphs.)

* must provide value

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Give an example of how you've contributed to a team. What qualities will you bring to your BHE team this summer?
(Please use complete sentences with a minimum of 2 paragraphs.)

* must provide value

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Activities, Volunteering Experience, Community Outreach, Jobs, etc. (Please list and describe a minimum of 3)

* must provide value

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Full Name

* must provide value

Relationship to Applicant

* must provide value

Phone Number

* must provide value

Upload Unofficial Transcript Here (PDF ONLY)

* must provide value

Upload file

How did you hear about this program?

Facebook

Twitter

Previous participant

Teacher or school administrator

BHE presentation in school

Family member

Other

Please specify.

Program Completed?

Yes

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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.