APPLICATION FOR

YOUTH SCIENCE FELLOWS PROGRAM

Sponsored by the UCI Cancer Research Institute

SUMMER 2015
(Due March 31, 2015)
Name:__________________________________________________________________
Address:_______________________City:________________State:_____Zip:_______
Students Home Phone #:__________________Cell Phone #:____________________
Email Address: __________________________________________________________
School:______________________________________Grade ( Current Year ) 11 or 12
Please attach the following: in PDF format
1) Official school transcript
2) A list of computer and/or math skills NOT TO EXCEED ONE PAGE
3) List any science-related experiences or honors (e.g. science fairs, volunteer work, after school
activities, internships) NOT TO EXCEED ONE PAGE
4) A personal statement describing applicants interest and reason for applying to the program,
typed in 12 font Ariel with one inch margin, single spaced, NOT TO EXCEED ONE PAGE
5) Letter of support/recommendation from a high school faculty member who can describe the
applicants lab experience and skill level (letter must be emailed separately from the
application by the teacher using their school email address to cri@uci.edu (with the students
name in the subject line of the email)
6) EVERYTHING MUST BE EMAILED IN PDF FORMAT. PAPER COPY WILL NOT BE
ACCEPTED.

Parents Statement: I understand how this opportunity might benefit my child and give
my permission for their involvement if selected. I agree to provide assistance with logistical
arrangements. (e.g. Transportation) as needed.
_____________________________________ _______________________________
(Parent Signature)
(Print Name)

Principals Statement: I have reviewed this students application and recommend him/her
for your consideration.
____________________________________ ________________________________
(Principal Signature)
(Print Name)

Faculty Sponsor: I have agreed to serve as the high school faculty sponsor as described in
the application packet.
_____________________________________ _______________________________
(Faculty Signature)
(Print Name)
Application must be submitted, on line, no later than 5:00pm on March 31st, 2015