Name:
First Name:
Middle Initial:
Last Name:
Current Address:
Street 1:
Street 2:
City: State:
Zip:
Daytime Phone:
Evening Phone:
Email Address:
Permanent Address:
Street 1:
Street 2:
City: State:
Zip:
Daytime Phone:
Evening Phone:
Email Address:
Education Information
College/University currently
attending: From (Date):
List any others that you attended:
From:
To:
Major(s): Date degree(s)
expected:
Personal Statement:
Please describe what you hope to gain through your
participation in the Summer Experiences in Aging Program. In
preparing this statement please indicate: 1) How you became
interested in aging; 2) What aspects of aging are of particular
interest to you (this will be helpful in deciding who might serve as
a mentor); 3) What types of research experiences you’ve had and how
they contributed to your decision to apply to the program; 4) What
your current long-term career goals are, especially with respect to
research and aging.
Previous Experience and Goals for the program
Please describe any research techniques or skills
(e.g., programming) that you have acquired through prior research
Please describe the types of experiences you would
like to have in the program and how you think they will contribute
to your long-term career goals.
List three areas in which you would like to
conduct research. Please be as specific as possible (e.g., “working
memory” is more helpful than just “memory”; “older adults and
transportation” is more helpful than “civil engineering”)
Demographic Information
(Voluntary)
The Harvey A.
Friedman Center for Aging seeks to attract students from all ethnic,
cultural, and racial backgrounds.
U.S. Citizen
Permanent Resident
Citizen
of Foreign Country
Racial
Identification:
Applications for the 2008 Summer Program must be submitted by March
24, 2008. NO EXCEPTIONS.
