Summer Scholars Program 2022 Registration

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Instructions

This is the registration form for the Summer Scholars Program. Any student working on summer research with a Department of Pediatrics mentor can participate in the Summer Scholars Program.

[If you complete the Research Fellowship application, you do not need to complete this form as well. Application for the Research Fellowship automatically enrolls you in the Summer Scholars Program.]

Student's Full Name *

Student's Current Institution (and campus if UIC) *

Student's Current Level of Training *

Student's Campus Email *

Student's Personal Email *

Student's Phone Number

Mentor's Name *

Mentor's Title

Please Include Position Title and Department

Mentor's Email *

Mentor's Phone Number

Project Proposal Title *

Submit

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