SMRI 2019

Student's name (last, first)*

Confirm that you are a US citizen, non-citizen national, or permanent resident:

US citizen
non-citizen national
US permanent resident

Check any that apply (see below for explanation):

I identify as an individual with a disability, per ADA definitions
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Prefer not to answer

WHY WE REQUEST THESE DATA: Extramural peer review and federal funding are highly valued components of our summer programs. As part of our compliance with federal policy, the National Institutes of Health (NIH) has requested that we provide aggregate data on participants from racial and ethnic groups who are under-represented in health-related sciences and individuals with disabilities. All information provided in this section is handled in a secure and confidential manner. For more information about what is considered a disability for these reporting purposes, please see the definitions in the Americans with Disabilities Act of 1990, as amended, which can be found here: https://www.ada.gov/pubs/adastatute08.htm#12102

UVA e-mail*

Research area(s) you are interested in pursuing - check one or more*

Cardiovascular, pulmonary, or blood
Cancer
Infectious diseases

Statement of research interests, to help match students and faculty projects (2 - 3 sentences max.)

SMRI statement of interest