2016 Summer Undergraduate Research Program (SURP) Application

High School students may only apply to the "Travis B. Lewis Scholarship Award".

Your application cannot be submitted without uploading your supporting documents.
Please have your documents ready to upload before filling out this application.
You will need your unofficial transcript, your resume, and your research essay.

* Required field. The form will not submit if the required fields are not filled out.
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First Name*     Last Name*
E-mail Address* (preferably NOT your email at school)
Phone Number* (include area code)
Current Address:
Street Address*
City*     State*     ZIP*

Home Address:
Street Address*
City*     State*     ZIP*

Eligibility Requirements: Only U.S.citizens  or students with permanent resident status may apply.*
DOB* e.g. 09/19/1980  
Racial/Ethnic Background (optional) Gender (optional)
Additional information:  
Are you the first person in your family to attend college? Yes No

Do you come from a disadvantaged background? Yes No
Answer "Yes" if you come from an environment that has inhibited you from obtaining the knowledge, skill and abilities required to enroll in and graduate from a school; OR if you come from a family with an annual income below a level based on low-income thresholds according to family size published by the U.S. census.
If Yes, please elaborate:

State/Country of School*
A cumulative GPA of greater than 3.25 is required. Current GPA*
Class Level* Anticipated Graduation Date* (month/year)
Current career goals* If "other" please list

Do you speak fluently any language other than English? Yes No

What language(s)?


You may apply to 3 SURP programs. If accepted, you must send a copy of required documents to each program selected.
High School students may only apply to the "Travis B. Lewis Scholarship Award".
Applicants must be US citizens or permanent residents to apply.
Please rank in order of preference (use 1, 2, or 3). Requirements
Per Program
Biochemistry/Molecular Biology February 1
Cellular and Integrative Physiology February 1
College of Nursing February 1
Eppley Institute for Research in Cancer February 1
Internal Medicine February 1
Internal Medicine Alcohol Research February 1
MD/PHD Scholars Program February 1
Pathology/Microbiology February 1
Pediatrics February 1
Pharmaceutical Sciences February 1
Pharmacology and Experimental Neuroscience February 1
Radiation Oncology February 1
School of Allied Health Professions
February 1
Travis B. Lewis Scholarship Award   (For high school students only.) February 1


Please upload only Word or PDF documents

Transcript:* Please upload your unofficial transcript.**

**If you are applying to Eppley Institute for Research in Cancer you must also mail an official transcript directly to their office.

Resume:* Please upload your resume in either Word or PDF

Essay:* Please upload your research essay in either Word or PDF

By submitting an application I understand any subsequent applications will be excluded and only the current application will be used and sent on to the selected departments.

By requesting that my application be forwarded to these Departments, I acknowledge the time commitment of approximately 10 weeks / 40 hrs each week (or otherwise prescribed by the dept) if accepted to their program.

I understand that my acceptance, if offered a position, is contingent upon fulfilling the immunizations required by the University of Nebraska Medical Center. I agree to submit the requested immunization form by May 1, 2016.

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