NI Summer Research Program

NATIONAL SPACE BIOMEDICAL RESEARCH INSTITUTE (NSBRI)

APPLICATION

Today's Date *

First Name *

Middle Initial

Last Name *

Date of Birth (ex. 01/01/1987) *

LOCAL ADDRESS *

Apt./Room:

City *

State *

Zip Code *

HOME ADDRESS (if different from above)

Apt./Room:

City

State

Zip Code

Country

Home Phone *

Contact number after leaving school

E-mail *

Emergency Contact Name & Number *

Type of Medical Insurance *

Institution *

GPA *

Major *

Minor

Classification

Student Status *

Year in School *

Career Goals (M.D., Ph.D or M.D./Ph.D.) *

Other

Please upload your CV.

Please upload your letter of interest.

Please upload your research experience (1-2 pages).

Please mail your (1) official transcripts and (2) two letters of recommendation by April 18, 2016 to the address below:

Morehouse School of Medicine
National Space Biomedical Research Institute (NSBRI)
720 Westview Drive SW – MRC F-241
Atlanta, GA 30310

For more information call (404) 756-5705