Frontiers in Addiction Research & Pregnancy Registration

REGISTRATION INFORMATION

Name *

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Last

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Are you a Permanent Resident of the U.S.? *

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No

If no, Citizenship

BEST MAILING ADDRESS:

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CURRENT PROFESSIONAL INFORMATION

Academic Institution

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Professional Status

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Degree Year

Please Specify "Other"

If you have previously applied to or attended a Frontiers/Advanced training course, please name the course and year

ADDITIONAL INFORMATION

If you are a member of an under-represented minority in science, please indicate below: (for U.S. Citizens and Permanent Residents only):

If Multi-Racial, Please specify:

Gender

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Female

Do you have a physical or mental impairment that substantially limits one or more major life activities?

No
Yes

FINANCIAL AID INFORMATION

Full financial assistance is available for participants in this course, including non-U.S. citizens who hold proper visas. Scholarships are awarded on the basis of need. Scholarship requests are not a factor in admissions decisions.

If applicable, please describe any financial considerations associated with your participation in this course:

REQUIRED SUPPORTING DOCUMENTATION

Provide a statement of your reasons for wanting to take this course by responding to the following questions:

I. Outline your background in biological sciences, including courses taken.
II. What experience, if any, in substance abuse, obstetrics, pediatrics and other relevant fields?
III. Are you currently studying addiction research during pregnancy and if so, please specify.
IV. What specific plans do you have for addiction research after completing the course?
V. Please describe your research goals, including basic science and/or clinical applications of the research.
VI. Will you be training other members of your laboratory?
VII. Given your experience and future plans, what particular topics would you like to address during the course?

Curriculum Vitae

Click or drag a file to this area to upload.

Allowed Formats: .pdf, .doc, .docx

Statement of Reasons