<p> Applicant's name:______Bronco #:______Date:______Cal Poly Pomona-Howard Hughes Medical Institute Undergraduate Research-Apprentice Application 2006-2007</p><p>Last name First name Middle Maiden Bronco#: SSN#:</p><p>Major Birthdate Gender (M/F) Ethnicity Acad. year (Jr/Sr) Graduation (Qtr/Yr)</p><p>Phone (home) Phone (cell) E-mail address</p><p>Street address City State and zip code</p><p>Name of Permanent Contact (eg. Parent) Relationship E-mail address</p><p>Permanent Contact Street address City/State/Zip code Phone (home)</p><p>Title of Research Project</p><p>Research Advisor Department Office Phone E-mail address</p><p>Laboratory Lab phone Short term degree objective (MS?) Long-term degree objective (PhD?/MD?)</p><p>Quarters of support that you are Su,'06 Su,'06-Sp'07 F,'06-Sp'07 applying for (check one box):</p><p>Number of units completed and GPA OR Honors thesis option? (Y/N?) Total units: GPA: (Minimum 2.8) Total units: GPA: (Minimum 3.3) First find a research advisor to sponsor you, then complete the application which includes: 1. This application face page (this page). 2. Research Proposal (max: one page; single-spaced, co-authored by student and research advisor). 3. Personal statement (max: one page; single-spaced). 4. College transcripts (may be unofficial copies). 5. Letter of support from Faculty research advisor (may be sent separately, but due by same deadline) Submit completed on-line form to Dr. Glenn H. Kageyama at [email protected] Submit signed paper copy to Dr. Kageyama c/o the Department of Biological Sciences (Rm. 8-119) by 5:00 pm on Monday afternoon, April 3, 2006. Please paper clip your complete application in the order 1-4 listed above. Do not staple. Have your research advisor e-mail a letter of support to Dr. Kageyama AND send a signed paper copy to the Department of Biological Sciences by the deadline.</p><p>CPP-HHMI Research Apprentice Applicant Research Advisor Signature: .Date: Signature: Date </p><p>GHK: rev.2/10/06 Applicant's name:______Bronco #:______Date:______2. Research proposal (max: 2 pages, single-spaced, Times font 12) Title/Authors </p><p>Background and Significance </p><p>Objectives </p><p>Experimental Approaches </p><p>References </p><p>GHK: rev.2/10/06 Applicant's name:______Bronco #:______Date:______3. Personal Statement describing expected educational or career benefits and relationship of these benefits to long-term goals (max: 1 page, single-spaced, Times font 12)</p><p>GHK: rev.2/10/06 Applicant's name:______Bronco #:______Date:______5. Letter of Support from Faculty Advisor</p><p>GHK: rev.2/10/06</p>