Name: Date of Citizenship: Date of Current mailing address: City: State: ZIP Code: Passport valid through 12/23/2012? Phone Number: E-mail: Yes/No: College/University: Expected graduation (Month/Year): Major: Current Standing (Sr, Jr, So, Fr): Semesters of Russian: Address: Phone: City: ZIP Code: Relationship of Individual(s) Residing at this Address: Name Institution/Department E-mail 1. 2. I verify the truthfulness of the information provided on this form and attachments. Electronic signature of applicant: Date: Signature of spouse Date: (only if for a joint membership): Please provide responses to each of the following in a separate document. Please number the sections 1 through 5 and use the heading provided. Submit as a PDF along with the completed application form. 1. Career Plans. Rationale for pursuing this study abroad opportunity and its relevance to your long-term educational and career plans. 2. Russian Experience. A description of prior Russian language study. 3. Previous Foreign Travel. A description of prior foreign study/travel experience. 4. Life Experience. A description of past experience that provides evidence of your ability to adapt successfully to challenging situations and requirements. 5. Science Experience. A description of laboratory research experience or scholarly activity in the sciences. Your application form and answers to additional questions should be e-mailed as a PDF to: Letters of recommendation should submitted by e-mail by the letter writer as a PDF to jsich@gwu.edu: One letter of recommendation from a science professor or research mentor who can provide insight into your potential for a career in biomedical research. One letter of recommendation from a foreign language professor who can assess your language proficiency and your potential to benefit from an intensive, immersion experience. An official transcript from the college or university you are currently attending. The transcript should be sent directly by your institution’s registrar to: Dr. Jeffrey Sich Dept. of Microbiology, Immunology & Tropical Medicine The George Washington University ■ ■ Medical Center 2300 Eye Street, NW; Ross Hall Room 731B Washington, DC 20037 ■ ■
Name: Date of Citizenship: Date of Current mailing address: City: State: ZIP Code: Phone Number: E-mail: Passport valid through 12/23/2012? Yes/No: College/University: Expected graduation (Month/Year): Major: Current Standing (Sr, Jr, So, Fr): Semesters of Russian: Address: Phone: City: ZIP Code: Relationship of Individual(s) Residing at this Address: Name Institution/Department E-mail 1. 2. I verify the truthfulness of the information provided on this form and attachments. Electronic signature of applicant: Date: Signature of spouse (only if for a joint membership): Date: Please provide responses to each of the following in a separate document. Please number the sections 1 through 5 and use the heading provided. Submit as a PDF along with the completed application form. 1. Career Plans. Rationale for pursuing this study abroad opportunity and its relevance to your long-term educational and career plans. 2. Russian Experience. A description of prior Russian language study. 3. Previous Foreign Travel. A description of prior foreign study/travel experience. 4. Life Experience. A description of past experience that provides evidence of your ability to adapt successfully to challenging situations and requirements. 5. Science Experience. A description of laboratory research experience or scholarly activity in the sciences. Your application form and answers to additional questions should be e-mailed as a PDF to: Letters of recommendation should submitted by e-mail by the letter writer as a PDF to jsich@gwu.edu: One letter of recommendation from a science professor or research mentor who can provide insight into your potential for a career in biomedical research. One letter of recommendation from a foreign language professor who can assess your language proficiency and your potential to benefit from an intensive, immersion experience. An official transcript from the college or university you are currently attending. The transcript should be sent directly by your institution’s registrar to: Dr. Jeffrey Sich ■ Dept. of Microbiology, Immunology & Tropical Medicine ■ The George Washington University Medical Center ■ 2300 Eye Street, NW; Ross Hall Room 731B ■ Washington, DC 20037
Moscow_Biotech_SU12_Application.docx