STUDENT RESEARCH TRAINING PROGRAM (SRTP)
      in DIABETES and ENDOCRINOLOGY
Welcome Students

The deadline for receipt of the completed application is February 15, 2010.

Please complete all questions in the Student Application below and please read the following:

  1. If you are NOT a Vanderbilt student, you will need to complete the Dean's Contact Information area of the Application. It is not necessary for Vanderbilt students to complete this area.
  2. After submitting the application, you will be directed to print a copy of the application. Please sign this printed application and also have your Dean sign it.
  3. Your signature certifies that all the information contained in your application is true. Your Dean's signature certifies that you are a student in good standing in your medical school.
  4. Vanderbilt Students must deliver or fax (DO NOT MAIL) your printed application signed by yourself and your Dean to:

    The Division of Diabetes, Endocrinology & Metabolism
    Administrative Office — 7465 MRB IV
    — OR — You may fax it to 615-936-1667.
  5. NON-Vanderbilt Students must mail or fax your printed application signed by yourself and your Dean to:

    Student Research Training Program
    The Division of Diabetes, Endocrinology & Metabolism
    Vanderbilt University Medical Center
    7465 MRB IV
    2213 Garland Avenue
    Nashville, TN 37232-0475
    — OR — You may fax it to 615-936-1667.

Application fields marked with a * are required. If you wish to submit documents (e.g., a CV or letter of recommendation) to accompany your application, you may upload these via the "Upload Document" fields located at the end of the application. You have the option of submitting two documents.

Applications will be reviewed promptly and you should expect a letter of action taken within one month of the deadline. For questions, please phone (615) 936-1760 or email suzanne.g.starr@vanderbilt.edu.

Please remember that you are expected to be present for 9-12 weeks at Vanderbilt and that you must be present at Vanderbilt early August 2010 for research presentations.

SRTP Student Application

* First Name:
Middle Initial:
* Last Name:
* Email Address:
** Biographical Information
(Please see additional information about this section of the form.)
* Date of Birth:
(mm/dd/yyyy)
* Social Security Number:
(xxx-xx-xxxx)
Gender: Male
Female
Are you Hispanic (or Latino): Yes
No
** Race/ethnicity — please select one:
(Please see additional information about this section of the form.)		 American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
United States Citizen: Yes
No
If not a United States citizen, are you a permanent resident? Yes
No
* Medical School Name:
* Medical School Address:
(street address):
* Medical School Class
(freshman, sophomore, etc.):
Note: The following 3 fields each hold approximately 200 words. If your response exceeds that amount, you may instead wish to create your response in a MS Word document (or another program), and use the "Upload Document" files below this form to submit your document.
* Why are you interested in diabetes or diabetes-related research?
* Please describe any prior research experience:
* Please indicate your current thoughts about long-range career plans and goals:
Address Information
* Current Mailing Street Address:
Current Mailing Street Address Two:
Current Mailing Apartment Number:
* Current Mailing City:
* Current Mailing State:
* Current Mailing Zip Code:
* Current Phone Number:
(xxx-xxx-xxxx)
* Permanent Mailing Street Address:
Permanent Mailing Street Address Two:
Permanent Mailing Apartment Number:
* Permanent Mailing City:
* Permanent Mailing State:
* Permanent Mailing Zip Code:
* Permanent Phone Number:
(xxx-xxx-xxxx)
For Non-Vanderbilt Students only - please provide your dean's contact information in the form below:
Dean's First Name:
Dean's Middle Initial:
Dean's Last Name
Title:
Address One:
Dean's Address Two:
Dean's City:
Dean's State:
Zip Code:
Phone: (xxx-xxx-xxxx)
Fax: (xxx-xxx-xxxx)
Email:
If you have additional documentation (e.g., resume, letter of recommendation), please email the document(s) to Suzanne Starr at suzanne.g.starr@vanderbilt.edu. In the email, be sure to include your full name and any other relevant information.
 
Please click the submit button only once.

Vanderbilt University is committed to principles of equal opportunity and affirmative action.
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Last updated: 10/30/2009