Ponce School of Medicine / Moffitt Cancer Center Partnership



Summer Experience Application Form

APPLYING FOR: Research Rotation Site:

8 Week Summer Research Rotation Ponce Health Sciences University (Ponce, PR)

8 Week Fall/Spring Research Rotation Moffitt Cancer Center (Tampa, FL)

CURRENT POSITION:

PHSU Medical student USF Medical student

PHSU MSMS student USF Master’s student; Dept.:      

PHSU Graduate student; Dept.:       USF Graduate student; Dept.:      

Moffitt Cancer Biology Graduate student

When the application form is completed please save the document and E-mail to both:

Lyshia M. Correa: lcorrea@psm.edu

Yairí Rivera-Torgerson: yairi.rivera-torgerson@

In addition to this application please provide by E-mail:

1. Curriculum Vitae

2. Undergraduate and Graduate transcripts: unofficial transcripts are acceptable for initial review (electronic transcripts are acceptable)

3. Two (2) letters of recommendation

4. Good Standing Letter (not required of USF/MCC students)

Boxes will expand as you type.

Name:      

Email:      

Phone:       Alternate Phone:      

Mailing Address:      

Emergency Contact

Name:      

Relationship:      

Phone:       Alternate Phone:      

Address:      

Persons providing Letters of Reference: (Please request your referees to send their confidential references directly to lcorrea@psm.edu and yairi.rivera-torgerson@)

|Name |University/Institute/Company |

|      |      |

|      |      |

EDUCATION

|School |Field of Study |Degree |When Attended |

|(Name and City) | | | |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

RESEARCH EXPERIENCE

|When |Where |Mentor |Project Title |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

CLINICAL ROTATIONS COMPLETED

|When |Where |Mentor |Rotation Title |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

|      |      |      |      |

Personal Letter of Interest: (Please do not exceed 2 pages. Include 1) prior relevant experience, 2) your career goals, 3) why you are interested in cancer research or oncology and 4) how this experience will help you achieve your career goals. You may compose your letter in another document and paste it below)

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download