Undergraduate Summer Internship Program Application - Society of University Surgeons (SUS)

Name(Required)

First Last

Email(Required)

Eligibility Confirmation(Required)

Eligible applicants must be full-time students enrolled in a Bachelor’s degree program in an accredited four-year college or university. Applicants must be citizens, non-citizen nationals of the United States, or have been lawfully admitted to the United States for permanent residence in possession of an Alien Registration Receipt Card (1-151 or 1-551) or other legal verification of admission for permanent residence. Non-citizen nationals are persons born in lands which are not States but which are under U.S. sovereignty, jurisdiction, or administration (e.g., American Samoa). Individuals on temporary or student visas are not eligible.

Yes, I confirm that I meet the above eligibility requirements.

Name of Four-Year College or University(Required)

List what year in college/university you are currently in:(Required)

List Your Major (if you have one):

Statement of Interest: Please provide a 1-2 paragraph statement of interest for this internship.(Required)

Applicants should be identified as under-represented in the biomedical or clinical fields, defined by the National Institute of Health (NIH) as: -Individuals from racial and ethnic groups that have been shown by the National Science Foundation to be underrepresented in health-related sciences -Individuals with disabilities, who are defined as those with a physical or mental impairment that substantially limits one or more major life activities -Individuals from disadvantaged backgrounds, defined as: Individuals who come from a family with an annual income below established low-income thresholds. These thresholds are based on family size, published by the U.S. Bureau of the Census; adjusted annually for changes in the Consumer Price Index; and adjusted by the Secretary for use in all health professions programs.

Pronouns

Please select your preferred pronouns:

She/Her

He/Him

They/Them

Other

You selected Other, please list your preferred pronouns here:

Gender

You selected Other, please list your gender here:

Race (Select all that apply)

American Indian/Alaska Native

Asian

Black or African American

Hispanic, Latino/a, or Spanish

Middle Eastern / North African

Native Hawaiian / Pacific Islander

White

Other

You selected Other, please list your race here:

Age

Geographic Preferences (Select all that apply)(Required)

I would prefer to be matched with a mentor in:

My City

My State

A Different State

Research Preferences (Select all that apply)

I prefer to be matched with a mentor in:

Basic Science

Health Services

Other

You selected Other, please list your research preference here:

Mentor Experience

I prefer to be matched with a mentor that:

Has a similar background experience

I have no preference

Letter of Support(Required)

Please upload a letter of support from a mentor from your college/university. You may also upload a secondary letter of support from a personal mentor, if appropriate. If there is a second letter, it should be combined to upload one document.

Accepted file types: pdf, Max. file size: 512 MB.