Example Application

Example Application for SRIP

This example application is given so that you may prepare your answers for the on-line application before you start it, especially those answers which require longer formats.

Use the on-line form to apply to the program.

Applicant FAQ

If you are ready to provide all of this information now, including both your Interests and Goals Statements, please proceed to the on-line application.

Personal Information
Year of Birth ONLY: (YYYY)
Last Name(s)
First, Middle Name(s)
Are you a U.S. Citizen?:
If no, are you a permanent resident of the U.S.?
If you are not a Permanent Resident or U.S. Citizen, please enter your current visa type here:

Current Address Information

(Your school address and contact information)
Address Line 1:
Address Line 2:
State/Country: Zip Code:
Current Telephone #:
Current Email:
This address information will be current until what date?

Permanent Address Information

(Address of parent, relative or other permanent address at which you can always be contacted)
Address Line 1:
Address Line 2:
State/Country: Zip Code:
Permanent Telephone #:
Other Email:

Education Information
High School Name & Date of Graduation:
City & State:
Undergraduate Institution:
GPA (Total): & GPA (In Major):
Year In School Major:
What are your academic degree goals after you complete your bachelor’s degree?
Where do you see yourself in 10 years? (1-2 sentences)
Are you currently supported by a Minority Access to Research Careers (MARC) Fellowship? If yes,
please provide the end dates of your award.
Do you anticipate being supported by a MARC Fellowship prior to next September?
List any honors, fellowships or special awards (e.g. MARC Scholar, NSF
or Howard Hughes Fellow, College or University recognition of achievement)


Please provide us with the full names of the people who will be providing recommendations for you. Two recommendations are required.
If accepted to SRIP, will you be available to start the program on the first day (at the end of May)? If not, please explain.
For our planning purposes, if you are accepted to participate in our SRIP this summer, would you take a GRE prep course if one were offered at no expense to you? If not, please elaborate as to why.
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 individuals with disabilities and individuals from economically, socially, culturally, or educationally disadvantaged backgrounds. All information provided in this section is handled in a secure and confidential manner.

I am a first generation college student.

My family has an annual income below established low-income thresholds.
For guidelines visit this site
I have received one of the following loans or scholarships
(Respond to all that apply):
Health Professional Student Loans (HPSL)
Loans for Disadvantaged Student Program
Scholarship for Individuals with Exceptional Financial Need
Federal Disadvantaged Assistance
You may provide us with information on other types of loans or aid that you have received in the field below:
For 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.I am an individual who has a physical or mental impairment that substantially limits one or more major life activities.
You may submit an optional statement that further describes your financial, historical, physical, mental circumstances or limitations.
Indicate your areas of research interest in order of
preference from the three lists below:
Area of Interest Preference indicate #1 #2 & #3Bioinformatics
Cardiovascular Biology and Disease
Cellular Growth/Regulation
Computer Modeling
Gene Expression
Gene Regulation
Hypertension/Renal Disease
Molecular Genetics
Molecular Pharmacology
Protein Structure and Function
Receptor Biology
Signal Transduction
Vaccine Development
Vascular Disease

Three Statements Required:
1. Past Research Experience and Long Term Goals (500 Word Maximum)
Compose a paragraph detailing any past experience in a research laboratory, even that associated with a class. This is your opportunity to explain your educational aspirations and why you want to participate in SRIP. Please try to address each of the following in your response: What are your academic and/or career goals? How have your past experiences and background influenced your goals? How will SRIP help you achieve your goals? What do you expect to gain from an SRIP experience?
(paragraph box for your text here)
2. Statement of Research Interest (125 Words Maximum)
In order to identify potential faculty mentors for you, the SRIP reviewers need to know what areas of research interest you.  Please describe the area(s) that you would like to explore and why this research appeals to you.  If familiar with research conducted at UVA, please list the faculty, departments, programs and/or research centers, with whom you would be interested in executing a summer project.
(paragraph box for your text here)
3. Other Relevant Information (125 Words Maximum)
Please share any additional relevant information or experience that you would like us to know about (volunteer, academic, life or work experiences).
There will be a button here on the application (click it only once, please!) which will submit your on-line application information and then take you to a page that provides instructions on how to submit SRIP Application Parts B and C.

B) Official Transcripts
C) Reference Forms
B-C Instructions Page
This is an example application.You must use the on-line form to apply to the program.
If you are ready to provide all of this information, including both Interests and Goals Statements now, please proceed to the on-line application.