2016 FDSRP Program Application

 IMPORTANT APPLICATION INFORMATION

All 2015 Four Directions Summer Research Program Required Supporting Materials must received by our office by Monday, February 8, 2016. 

Prepare & Submit Online Application

  • Write your answers to the Essay Questions –
  • In 250 words or less, please describe your involvement in the Native American Community. Please be sure to include any hobbies, cultural activities or volunteer work that may demonstrate your contribution to the lives of Native People.
  • In 250 words or less, please describe your interest in medicine or biomedical research, including what your goals are and how you hope to benefit yourself and your people by participating in the Four Directions Summer Research Program.
  • Please include a header on all pages with your last name. Upload your essays as Word Documents or PDF files. Please be sure your Word documents are saved as .doc files.
  • Choose a Photo (2in x 2in) – jpg less than 1MB
  • Choose 2 Letter of Recommendation Writers and collect their contact information
  • Complete online application and upload each of your essays & photo
  • Confirm Receipt of Confirmation Email from FourDirections@partners.org

Request your Required Supporting Materials and confirm they are to be received by our office by Monday, February 8, 2016:

  • 2 Letters of Recommendation – you must make these requests

Acceptable Methods of Submission for Required Supporting Materials:

  • Fax:  
    (617) 264-5110 
  • Email: 
    FourDirections@partners.org
    (Letters of Recommendation may be emailed ONLY by the letter writer)
  • Physical Address: 
    Four Directions Summer Research Program
    1620 Tremont Street, 3-014
    Boston, MA, 02120

Questions?

FourDirections@partners.org
or
(617) 525-8356

Applicant Information

First Name*
Middle Initial
Last Name*
Email*
Alternative Email
DOB (MM/DD/YY)*
Age*
Gender (M/F)*
Tribe 1*
Tribe 2
Citizenship*
Are you covered by health insurance that will continue throughout the summer program?*
MCAT:
How did you hear about FDSRP?*
If other please specify:

Current Contact Information

Current Address*
Current Address 2
City/Town*
State*
Zip/Postal Code*
Country
Current Phone Number*

Permanent Contact Information

Permanent Address*
Permanent Address 2
City/Town*
State*
Zip/Postal Code*
Country
Permanent Phone Number*

Emergency Contact Information

Contact's Full Nme*
Relation*
Phone Number*
Address*
Address 2
City/Town*
State*
Zip/Postal Code*
Country
Emergency E-mail Address

Education

Current Academic Institution
Location (City, State)
Overall GPA
Current Status (Freshman, Sophomore, Junior, Senior)
Major/Area of Interest
(Expected) Degree
(Expected) Graduation (MM/DD/YY)
Completed College-Level Math and Science Courses:
Other
Additional Colleges Attended
CollegeDates AttendedMajor/Area of InterestDegree

Extracurricular Activities

Extracurricular Activity 1
Institution/Organization
Dates of Participation (MM/YY)
Extracurricular Activity 2
Institution/Organization
Dates of Participation (MM/YY)
Extracurricular Activity 3
Institution/Organization
Dates of Participation (MM/YY)
Extracurricular Activity 4
Institution/Organization
Dates of Participation (MM/YY)

Research Experience (Not Required)

Research-Related Work 1

Position
Institution/Organization
Dates of Employment (mm/YY-MM/YY)
Briefly describe the research project and your project duties:

Research-Related Work 2

Position
Institution/Organization
Dates of Employment (mm/YY-MM/YY)
Briefly describe the research project and your project duties:

Research-Related Work 3

Position
Institution/Organization
Dates of Employment (mm/YY-MM/YY)
Briefly describe the research project and your project duties:

Research-Related Work 4

Position
Institution/Organization
Dates of Employment (mm/YY-MM/YY)
Briefly describe the research project and your project duties:

Honors/Awards

Honor/Award 1
Institution/Organization
Date Received
Honor/Award 2
Institution/Organization
Date Received
Honor/Award 3
Institution/Organization
Date Received
Honor/Award 4
Institution/Organization
Date Received

Native American Community Involvement

 

Please describe your involvement in the Native American Community. Please be sure to include any hobbies, cultural activities or volunteer work that may demonstrate your contribution to the lives of Native People. (250 words or less)

Please include a header on all pages with your last name. Upload your essay as a Word Document or a PDF file. Please be sure your Word Doocument is saved as a .doc file.

Upload your Essay
FDSRP is expanding our partnership to include Harvard School of Public Health faculty mentors in addition to the current Harvard Medical School faculty mentors. In the summer of 2015 a few students will have the opportunity to complete a public health or health policy research experience. Please indicate your preference for the FDSRP research experience: *

Your response will not impact your chances of acceptance into the program.

In 150 words or less, please describe what you would like to gain from your research experience.

 

Interests and Goals

Please describe your interest in medicine or biomedical research, including what your goals are and how you hope to benefit yourself and your people by participating in the Four Directions Summer Research Program. (250 words or less)

Please include a header on all pages with your last name. Upload your essay as a Word Document or a PDF file. Please be sure your Word Doocument is saved as a .doc file.

Upload your Essay

Letters of Recommendation

We would like to receive letters of recommendation that can attest to 1) your relationship to Native American communities, and 2) your academic potential. These letters can come from a combination of community leaders, instructors, or counselors.

Please list the two (2) faculty individuals who will be submitting letters in support of your application.

You are responsible for requesting these letters of recommendation.

Full Nme & Title(1)*
Institution/Organization*
Rec 1 Email Address*
Full Nme & Title(2)*
Institution/Organization*
Rec 2 Email Address*

Letters of recommendation must be received by February 8, 2016 and addressed to:

Four Directions Summer Research Program
1620 Tremont Street, 3-014
Boston, MA, 02120

If you have additional questions please contact us via email at FourDirections@partners.org.

Photo

Please upload a photo of yourself. Photo should be at least 2 x 2 in. and should not exceed 100KB in size.

Applicant Consent Form

I attest that all information is true and understand that any misrepresentation or falsification of the content submitted will result in the rejection of my application and/or subsequent dismissal from the program.

I understand that the information contained in this application is confidential and will only be used by the Four Directions Summer Research Program for review and selection purposes.

*