| Last Name |
First Name |
Middle Initial |
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| Permanent Address |
| |
| Campus Address |
| |
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| College or University of Enrollment |
| |
|
| Department/Program of Study |
| |
|
| GPA - Overall |
|
GPA - Engineering |
|
|
| Expected Date of Graduation |
| |
|
| List of courses in which currently
enrolled |
| |
| |
| |
| |
| |
|
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| Computer languages and applications
in which you are proficient |
| |
| |
| |
| |
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| Hobbies, Sports and Other Recreation |
| |
| |
| |
| |
|
| Organizational Memberships |
| |
References
| Name |
Phone |
Relationship to you |
| |
|
|
| |
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| |
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| |
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| Any information you choose to volunteer
with respect to gender, age, race, national origin, physical capability,
or other similar factors |
| |
|
Additional Materials for Application
- Official copy of current transcripts for all colleges and universities
attended.
- Resume summarizing previous employment, other experience relevant
to personal development.
- Biographical essay, including career goals, scientific background
and reasons for applying for the program.
- Brief commentary on preferred CCf mentor and project area.
- Two letters of reference from the faculty members at the home institution.
|
| For further information, please contact:
| Katie Root
Education Coordinator
Cleveland Clinic Foundation
Dept. of Biomedical Engineering/ ND20
9500 Euclid Avenue
Cleveland, Ohio 44195 |
Phone 216-445-9343
Fax: 216-444-9198
E-mail: rootc@ccf.org |
|
