Stanford Institutes of Medicine Summer Research Program (SIMR)

PROGRAM DATES: JUNE 14- AUGUST 6, 2010

APPLICATION DEADLINE: February 24, 2010

Please read the Program Information document before you apply. Please print legibly
(or preferably type), and keep a copy for your records

Personal Information:
Name: __________________________________________________________
Last First
Middle
Street Address:
City, State, Zip Code:
Home Phone #: ( ) Cell Phone #: ( )
Email Address:
Sex: M_____ F_____
Date of Birth:
Are you a U.S. Citizen or Resident Alien? Yes_____ No______
IF you checked NO, you are not eligible for the program

Parents/Guardian Information:
Name: __________________________________________________________
Last First Middle
Name: __________________________________________________________
Last First Middle
Street Address: (if different from above)
City, State, Zip Code:
Phone Number: ( )
Email Address:
Have your immediate family members (mother, father, siblings) attended college?
____yes ____no
Parent or Guardian’s Education Level (highest degree attained):
Mother/guardian: ____________________ Father/guardian: ___________________

High School Information:

School currently attending:
City, State:
Expected year of graduation: ___ class of 2010 ___ class of 2011
IF NOT 2010 OR 2011, you are not eligible for the program. Please DO NOT continue
with the application.
Most Recent Cumulative GPA: weighted _________ ; unweighted _________
Test Scores, if taken (please provide copies of test scores if available):
SAT I- date taken/score(s):
SAT II- date taken/score(s):
PSAT- date taken/score(s):
Other tests- date taken/score(s):

Have you applied previously to the SIMR Program? Yes _____ N o _____
If accepted, will you require a parking permit? Yes _____ No _____
Will you be commuting by bus/train? Yes _____ No______
Race (For Statistical and Reporting Purposes only):
Caucasian ____ African-American ____
Asian/Pacific Islander (please specify) _______________ Hispanic ____
Native American/Alaska Native ____ Other (please specify)
________________________

 The SIMR Program will enlist labs from 5 different Institutes within the School of
Medicine. According to your research interest, please rank from 1-5 (with 1 being your first
choice). Please see the Institute program descriptions in the Program Information document
for more information.

___ Immunology
___ Cancer Biology (under-represented minority students are especially encouraged to apply)
___ Stem Cell Biology
___ Neuroscience
___ Cardiovascular Medicine

 How did you find out about the SIMR Program? __________________________

Please list any Honors and Awards (circle year that it was received)
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Please list any extracurricular or community activities, internships,

interests – please also list any positions held (circle years of
involvement)
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Please list any Honors or AP Courses taken (circle year it was taken)
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Please list all the science and math courses you have completed or are
currently taking and include the letter grade you have received per
class:

Course Name Grade Received Course Name Grade

Received

ESSAYS:
Please answer the following two essays on a separate sheet of paper. Please use font size 12
(Times New Roman or Arial). Your essays combined should not exceed 2 double-spaced pages
total.

Essay #1: Please summarize the reasons that you are applying for the SIMR Program, how your
participation in the program fits into your future educational and career objectives, and why you feel
you are a good candidate for the program. You may also discuss your institute/area of research
preferences and personal goals.

Essay #2: At Stanford, we are committed to increasing the diversity (broadly defined) of students in
the sciences and engineering. Please describe how your interests and background (in terms of
culture, class, race, gender, ethnicity, work, hardships that you’ve faced or life experiences) would
contribute to that diversity.

-----------------------------------------------------------------------------------------------------------------------
I certify that the information provided in this application is true and correct to the best of my
knowledge.

Applicant’s Signature Date

Parent/Guardian’s Signature Date

 SIMR APPLICATION CHECKLIST:

Please provide the following additional materials to complete your application and
mail in as a single packet:

Checklist:

_____1. A complete Application Form

_____2. A maximum of one (1) letter of recommendation from a science or math teacher
who can accurately describe your academic potential, scientific knowledge, interest in
learning, and work ethic. The letter should be placed in a sealed envelope, signed and
dated on the back by the author, and included in your application packet. If more than one
letter is sent, only one of them will be selected at random and opened, the other will be
discarded. Please give the teacher the letter of recommendation cover letter that is found
on the following page. This cover letter must accompany the letter and should also be
placed in the sealed envelope.

_____ 3. A copy of your high school transcript (unofficial is acceptable), must be included
in your application packet.

_____ 4. A copy of your SAT or PSAT scores (unofficial is acceptable) must be included in
your application packet.

_____5. 2 essays previously described in the application

_____6. This completed checklist

All application materials must be submitted in the SAME ENVELOPE (including the
sealed letter of recommendation) to the following address:

SIMR Program
c/o Dr. P.J. Utz
269 Campus Drive
CCSR-Rm. 2215A (Mail Code: 5166)
Stanford, CA 94305-5166

We will start accepting applications from Feb. 1st. The application deadline is Feb.
24, 2010. Applications must be postmarked at the latest by Wednesday, Feb. 24,
2010 in order to be eligible. If you have any questions, please email:
simr-program@stanford.edu.
Stanford Institutes of Medicine Summer Research Program (SIMR)
PROGRAM DATES: JUNE 14- AUGUST 6, 2010
APPLICATION DEADLINE: February 24, 2010

Recommendation Letter Cover Sheet

Applicant Name:__________________________________________

Recommender Name:_______________________________________

Title:________________________________________Phone:_____________________

Address:_______________________________________________________________

Email:______________________________________

Dear Recommender:

The Stanford Institutes of Medicine Summer Research Program is an 8-week summer program in
which high school students, from diverse backgrounds, will be invited to learn how to do basic
research while working closely with Stanford faculty, students, and researchers on a research
project. Your honest appraisal of this student and his/her potential to contribute to and benefit
from participation in the summer program will be greatly appreciated. As you write your letter of
recommendation, please address the following on a separate sheet of paper:

• How long, and under what capacity, have you known the applicant?
• How would you assess the student’s ability and interest in science?
• Do you feel the student demonstrates maturity and initiative? Please give any examples.
• Are you aware of any hardships that may affect the student’s academic performance?
• How would you rank the applicant against other students in your course(s)? (check
answer)

___Top 1% ___Top 5% ___Top 10% ___Top 25% ___Top 50%

___Bottom 50% ___Bottom 25%

Please return your sealed letter of recommendation with this cover letter to the student applicant
for inclusion in his/her complete application packet. Please keep a copy of your letter of
recommendation on file in the event the original is lost in the mail. Please note that application
materials must be postmarked by Feb. 24, 2010. Please email simr-program@stanford.edu if
you have any questions.

Signature________________________________________________Date___________