STREAMS - Research Opportunities in Biomedical Sciences WSU Boonshoft School of Medicine 3640 Colonel Glenn Highway Dayton, OH 45435-0001 APPLICATION (please type or print legibly) *Required information *Name_____________________________________ Social Security #____________________________________ *Undergraduate Institution_______________________________________________________________________ *Date of Birth: Class: Freshman Sophomore Junior Senior Post-bac Major_____________________________________ Expected date of graduation___________________________ SAT (or ACT) scores: VERB_________MATH_________Test Date_________GPA__________ *Applicant’s Current Mailing Address *Mailing Address After ____________(Give date) _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ _________________________________________ Phone # : Day (____)_______________________ Phone # : Day (____)_______________________ Eve (____)_______________________ Eve (____)_______________________ *Email Address:_____________________________ FAX number: (____)_______________________ Where did you learn about this program?:__________________________________________________________ *Are you a U.S. citizen or permanent resident? Yes No (You must be a citizen or permanent resident to participate in this program) *Please indicate the group(s) in which you would include yourself: Native American/Alaskan Native Black/African-American Hispanic Pacific Islander, please specify**_________________________ Disabled **See attached list Rank your preferred area of interest from 1(most preferred) to 3 (least preferred): Cellular/Molecular Biology Endocrinology/Hypertension Cardiovascular Epidemiology (Human Biology) INSTRUCTIONS:(All of the following material MUST be submitted before an application will be considered.) Statement of Academic Interest and Career Goals: Statement should be one typewritten page. Transcript: Official copy of undergraduate transcript (including fall semester grades) sent by institution. Letters of Recommendation: Two letters of recommendation from academic faculty. Mail applications to: STREAMS Lifespan Health Research Center WSU Boonshoft School of Medicine 3171 Research Blvd. Dayton, OH 45420-4006 Phone: (937) 775-1304; Fax: (937) 775-1456 Program Dates: Summer 2016 Stipend: $400 per week, plus travel expenses and free housing in WSU apartments. The application deadline is March 4, 2016. PacificPacific IslandsIslands • American Samoa (United States) • Viti Levu o Aunuu • Vanua Levu o Ofu • Significant outliers: o Olosega • Conway Reef o Rose Island • Kadavu o Swains Island (Olosenga, • Taveuni Olohega) (disputed) • Rotuma o Tau • Archipelagos: o Tutuila • Kadavu Group • Baker Island (United States) • Lau Islands • Caroline Islands (Federated States of • Lomaiviti Islands Micronesia; Palau) • Mamanuca Islands o Federated States of Micronesia • Moala Islands • Pohnpei • Ringgold Isles • Yap • Rotuma Group • Ulithi • Vanua Levu Group • Chuuk • Viti Levu Group • Puluwat • Yasawa Islands • Kosrae • French Polynesia ("Tahiti", Autonomous • Palau Overseas Territory of France) • Babeldaob o Austral Islands • Ioueldaob • Tubuai • Koror • Society Islands • Southwest Islands • Iles du Vent (Windward Islands) • Clipperton Island (France) • Moorea • Cook Islands • Tahiti o Aitutaki • Tetiaroa o Atiu • Maiao o Palmerston • Mehetia o Mangaia • Iles Sous le Vent (Leeward Islands) o Manihiki (Humphrey) • Bora Bora o Manuae (Hervey) • Huahine o Mauke (Parry) • Maupiti o Mitiaro • Raiatea & Tahaa o Nassau • Tupai o Pukapuka (Danger) • Mopelia (aka Maupihaa) o Rakahanga (Reirson) • Manuae (aka Scilly Atoll) o Rarotonga • Motu One (aka Bellinghausen) o Suwarrow (Anchorage) • Marquesas o Takutea • Fatu Hiva o Tongareva (Penrhyn) • Hiva Oa • Desventuradas Islands (Chile) • Nuku Hiva • East Timor • Tahuata • Easter Island/Rapa Nui (Chile) • Ua Huka • Fiji Islands • Ua Pou o Principal islands: • Tuamotus • Rangiroa o Tabuaeran/Fanning Island • Fakarava (Kiribati) • Moruroa o Teraina/Washington Island • Fangataufa (Kiribati) • Gambier Islands o Tongareva/Penhryn Island • Mangareva (Cook Islands) • Helena Island o Vostok Island (Kiribati) • Galapagos Islands (Ecuador) • Lord Howe Island (Australia) • Gilbert Islands (Kiribati) • Marcus Island (Japan) • Hawaii (United States; see also • Marianas Islands (United States) Hawaiian Islands) o Guam o Main islands o Northern Marianas Islands • Hawai • Saipan • Kahoolawe • Rota • Kauai • Tinian • Lanai • Maug • Maui • Pagan Island • Molokai • Alamagan • Niihau • Farallon de Pajaros • Oahu • Marshall Islands • Northwestern Hawaiian Islands o Bikini • Kaula o Enewetak • Nihoa o Kwajalein • Necker o Rongelap • French Frigate Shoals o Majuro • Gardner Pinnacles • Norfolk Island (Australia) • Maro Reef • Federated States of Micronesia • Laysan (Caroline Islands) • Lisianski o Chuuk (Truk) • Pearl and Hermes Reef • Puluwat • Midway • Pohnpei • Kure • Kosrae • Howland Island (United States) • Yap • Johnston Atoll (United States) • Ulithi • Juan FernándeZ Islands (Chile) • Nauru • Kermadec Islands (New Zealand) • New Caledonia ("Kanaky", France) o Macauley Island o Chesterfield Islands o Raoul Island o Ilots du Mouillage • Line Islands o New Caledonia o Caroline Island • Isle of Pines o Flint Island (Kiribati) • Belep Islands o Jarvis Island (United States) • New Caledonia o Kingman Reef (United States) • Loyalty Islands o Kiritimati/Christmas Island • Bagao (Kiribati) • Lifou Island o Malden Island (Kiribati) • Maré Island o Palmyra Atoll (United States) • Ouvéa Island o Starbuck Island (Kiribati) • Tiga Island • New Zealand ("Aotearoa", see also o Uki Islands of New Zealand) • Tokelau o Chatham Islands o Atafu (Duke of York Island) • Chatham Island o Fakaofo (Bowditch Island) • Pitt Island o Nukunonu (Duke of Clarence • D'Urville Island Island) • Great Barrier Island o Olohega (Swains island) • Kapiti Island (disputed) • North Island • Tonga (only main islands or groups, on • South Island north-south order. See also complete • Stewart Island/Rakiura list of islands in Tonga) • Waiheke Island o Niuafoou • Niue (Savage Island) o Niuatoputapu (Keppel's Island) • Papua New Guinea o Vavau o Bismarck Archipelago o Kao • Admiralty Islands o Tofua • New Britain o Haapai • New Ireland o Tongatapu • Saint Matthias Group o Eua • Bougainville • Torres Strait Islands (Australia) • D'Entrecasteaux Islands • Tuvalu (see also Islands of Tuvalu) • Louisiade Archipelago o Funafuti (atoll of at least 30 • Trobriand Islands islands) • Phoenix Islands (Kiribati) o Nanumanga (or Nanumaga) • Pitcairn Islands (UK) o Nanumea (atoll of at least 6 • Revillagigedo Islands (Mexico) islands) • Samoa o Niulakita o Savaii o Niutao o Upolu o Nui (atoll of at least 21 islands) o Apolima o Nukufetau (atoll of at least 33 • Solomon Islands (see also Islands of the islands) Solomon Islands) o Nukulaelae (atoll of at least 15 o Bellona islands) o Choiseul o Vaitupu (atoll of at least 9 o Florida Island islands) o Guadalcanal • Vanuatu (New Hebrides; see also o Malaita Islands of Vanuatu) o Maramasike o Ambrym o New Georgia Islands o Anatom o Rennell o Aoba o Russell Islands o Éfaté o San Cristobal o Erromango o Santa CruZ Islands o Espiritu Santo o Santa Isabel o Futuna o Shortland Islands o Hunter (claimed by France and o Sikaiana (Stewart Islands) Vanuatu) o Tulagi o Îles Banks o Ulawa o Îles Torres o Maéwo o Matthew (claimed by France and Vanuatu) o Malakula o Pentecóte o Tanna • Wake Island (United States) • Wallis and Futuna (France) o Alofi o Futuna o Wallis (Uvea) • Willis Island (Australia) .