| Personal
Information |
| Name |
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Mr.
Ms.
Dr. |
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First
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Middle
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Last (Family)
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| If transcripts, test scores,
or other documents are under another name, give name
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| Permanent Address |
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Number and Street
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Apartment (if applicable)
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City
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State
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Zip Code
-
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Country
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Business Telephone
x
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Fax
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Email (required)
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Home Telephone
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| If necessary, may we
contact you via: |
Business Telephone?
Yes
No |
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Fax?
Yes
No |
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Email?
Yes
No |
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| Mailing Address (if different
from above) |
|
Number and Street
|
Apartment (if applicable)
|
City
|
State
|
Zip Code
-
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|
Country
|
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| Academic
/ Educational Background |
| Colleges and Universities |
|
| Provide the following information
in chronological order (with most recent first) for all colleges
and universities attended. |
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| Application
for |
| Term
Spring 2010 |
|
Program
Fundamentals of the Bioscience Industry |
Student $4250
|
Non-student $4250
|
Location
Stony Brook University (January 26 – May 13, 2010) |
|
|
Stony Brook Manhattan (January 26 – May 13, 2010) |
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| |
|
If you are not accepted to
the Spring 2010 session, would you like your name to be placed
on the waiting list?
Yes
No
|
| A limited number of partial
scholarships from the Center for Biotechnology, based on
merit, are available. Do you wish to be considered for a
partial scholarship?
Yes
No
Applicant Requirements:
. Only student applicants are eligible for the above Center for Biotechnology awards.
. Students are strongly encouraged to apply early. |
| |
| Essay (Required) |
In an essay of 500 to 700
words, please discuss your reasons for wanting to participate
in the program and explain your interest in exploring opportunities
in the bioscience industry. Include in your essay your career
goals, expectations upon completion of the program
and sectors of the bioscience industry that you are most
interested in i.e biotechnology, pharma, medical devices
etc.
*Please note that your essay will be reviewed by an Application
Review Committee comprised of industry leaders.
Essay to Upload:
|
| |
| Resume (Required) |
Supply a one to two page
resume of your academic, employment and all relevant experience.
Please include titles and current responsibilities.
Please upload your resume below.
Resume to Upload:
|
| |
| All Applicants
- Confidentiality Agreement (Required) |
| Due to nature of the project that will be worked on during this program, students admitted to the Spring 2010 program will be asked to sign a Confidentiality Agreement for the Center for Biotechnology. Please indicate your agreement to this condition before proceeding with your application. |
|
I Agree Date
(mm/dd/yyyy) |
| |
| All Applicants
- Statement of Certification (Required) |
| I certify that all statements
made in this application for admission to the Center for Biotechnology
are correct, that the information supplied is complete, and
that the essay(s) have been written by me. I understand that
my application and all supporting materials become the property
of Center for Biotechnology and cannot be returned or sent
elsewhere. I understand that withholding or giving false information
will make me ineligible for admission to the Center for Biotechnology's
Fundamentals of the Bioscience Industry program. I also understand
that the application fee may not be waived nor is it refundable.
|
|
I Agree Date
(mm/dd/yyyy) |
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