Frontiers in Emerging, Re-Emerging, and Zoonotic Diseases and Diversity Registration

REGISTRATION INFORMATION

Name *

First

Last

E-mail *

Phone *

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

Yes
No

If no, Citizenship

BEST MAILING ADDRESS:

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

CURRENT PROFESSIONAL INFORMATION

Academic Institution

How did you learn about this course? *

Professional Status

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):

Gender

Male
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 emerging, re-emerging, and zoonotic diseases and other relevant fields?
III. Are you currently studying emerging, re-emerging, and zoonotic diseases, and if so, please specify.
IV. What specific plans do you have for emerging, re-emerging, and zoonotic diseases 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

Click or drag a file to this area to upload.

Allowed Formats: .pdf, .doc, .docx

EVALUATIONS

Applicants should request one (1) written letter of recommendation from an individual familiar with the applicant's research, leadership background, and career goals. Evaluations may be submitted with other application materials by the candidate or sent directly to the MWRI/PDC Admissions Office, frontiers@mwri.magee.edu, by the evaluator by the deadline listed above. This letter of recommendation may come from a community member, educator, or supervisor.

Evaluation 1

Click or drag a file to this area to upload.

Allowed Formats: .pdf, .doc, .docx

Registration

REGISTRATION INFORMATION

BEST MAILING ADDRESS:

CURRENT PROFESSIONAL INFORMATION

ADDITIONAL INFORMATION

FINANCIAL AID INFORMATION

REQUIRED SUPPORTING DOCUMENTATION

EVALUATIONS

THE PITTSBURGH DEVELOPMENT CENTER