We're looking for people just like you to become
a Cultural Diversity Research Scholar!

Look at what the Cultural Diversity Research Program can offer you …

· A five-week intensive summer research component.
· A $40 per day stipend for qualified applicants to be used for personal expenses.
· Close interaction with an MSU faculty mentor.
· Scholarly writing and research presentation tutorials.
· Research methods tutorials.
· Library skills component.
· Resume development.
· Participation in student and professional research conferences.
· Participation in research oral and visual presentations and much more …
· Up to an additional four weeks with additional stipend may be added with prior approval from the faculty mentor and program coordinator.

Applicants must:
· Be able to commit six consecutive weeks from July 09 - August 0, 2002 (6 hours per day);
· Be a current CHM Medical Scholar (Senior), ABLE, Block I (extended) or Block II (with second CMC) student in good standing in the College of Human Medicine;
· Be a US citizen or permanent US resident;
· Belong to a group underrepresented in medicine, including African-American, Alaskan Native/Native American, Mexican American/Puerto Rican or other Latino (non-minority students may participate on alternative funding); and
· Submit the completed application packet to:

Office of Student Affairs and Services
A-234 Life Sciences Building
East Lansing, MI 48823.

Deadline: Tuesday, April 30, 2002.

Your application and further details are below:

CULTURAL DIVERSITY RESEARCH PROGRAM
2002 APPLICATION

(PROGRAM DATES: July 9, 2002 to August 0, 2001)

Center of Excellence in Minority Medical Education and Health
Michigan State University College of Human Medicine

Submission Deadline: Friday, April 30, 2002 at 5:00 p.m.

I. APPLICANT INFORMATION (PLEASE TYPE IN BLACK INK)

NAME:
(Last, First, Middle)

CURRENT ADDRESS:
(Street Address, City, State, Zip Code)

TELEPHONE NUMBER: E-mail

PLACE OF BIRTH:
(City, State, Nation)

DATE OF BIRTH:
(Month, Day, Year)

SEX: ( ) Female ( ) Male

CITIZENSHIP: U. S. Citizen
Permanent Resident (Number )
(If applicable, please provide a photocopy of INS documentation)

SOCIAL SECURITY NUMBER PID NUMBER

ETHNIC HERITAGE: (Check all that apply.)
African-American
Alaskan Native/Native American
Asian-American
Caucasian/White
Mexican-American/Puerto Rican/Other Latino
Other (please specify)

Are you a handicapper student? Yes No
If yes, what are the characteristics?

II. EDUCATION INFORMATION

Undergraduate Major(s)

Advanced Degree(s)

Previous research experience

Research interest

Class standing: † Medical Scholar: Year ABLE Block I Block II

Total Credits Earned
Anticipated Graduation Date
( Month, Year)

Have you participated in the Cultural Diversity Research Experience Program in the past?
Yes No
If yes, when?

Have you participated in other research programs? If so, please give the name of the program and explain your role/ responsibilities:

What residency program(s) are you interested in?

III. PERSONAL STATEMENT
Please attach a personal statement which describes your background, your interest in research, and academic medicine.

IV. TRANSCRIPTS
Please submit a set of unofficial transcripts from the CHM Registrar.

V. LETTER OF RECOMMENDATION
At least one letter of recommendation must be submitted from a CHM faculty member who knows you academically.

PS: YOU MUST PRINT NOW. Fill out the rest on a typewriter and sign.

VI. CONTRACT OF UNDERSTANDING
My signature below indicates that, to the best of my knowledge, the information given on this application is true, complete and accurate. Furthermore, I understand that, if accepted into the Cultural Diversity Research Program, I will be required to complete my project and submit any required documentation to the Center of Excellence prior to receiving my stipend. Also with the permission of my research mentor, I grant to MSU the non-exclusive, perpetual, royalty-free right to publish my project on the COE website. I present and warrant that this abstract does not infringe on any existing copyright or other legal right.

Date ___________________________ Signature ______________________________________

RETURN FULLY COMPLETED APPLICATION, TRANSCRIPT AND LETTER OF RECOMMENDATION TO THE OFFICE OF STUDENT AFFAIRS AND SERVICES BY THE DEADLINE

APPLICATION PROCESS CHECKLIST

Have you:
. Completed your part of the application?
. Provided a photocopy of INS documentation, if applicable?
. Included the faculty recommendation?
. Included your personal statement?
. Signed and dated the application?
. Detached and kept this checklist and information jacket for your files?
. Delivered or sent application packet by deadline?

Thank you for your interest in the Cultural Diversity Research Program. We look forward to hearing from you and receiving your application. You have provided vital information that will help us in the decision-making process.

[The Center of Excellence in Minority Medical Education at Michigan State University is partially supported by the federal assistance made possible from the Division of Disadvantaged Assistance, Bureau of Health Professions, Health Resources and Services Administration of the US Public Health Service.]