Application Form Psychiatry Summer Training and Research (P-STAR) Program Department of Psychiatry and Behavioral Sciences Johns Hopkins University, School of Medicine 5/28/2013 – 8/2/2013 (*Please type or print clearly) Name (Last, First Middle): (Enter name exactly as it appears on official documents) Current Address: City: State: Zip code: Phone (Day): ( ) - Phone (evening): ( ) - Cell Phone: ( ) - E-mail address: Date of Birth (MM/DD/YYYY): / / Are you a US Citizen or permanent resident? Yes No Permanent Address: City: State: Zip code: Phone: ( ) - E-mail address: Current attending Institution: Location: From (date): To Year in School: Expected Date of Graduation, (MM/YYYY): / If you are accepted, do you require summer housing in Baltimore area? Yes No References: Two letters of recommendation are needed. 1. Name: E-mail: 2. Name: E-mail: Ethnic Origin: American Indian or Alaskan Native Hispanic Asian White Pacific Islander Other Black/African American How did you hear about our program? Answer the following 2 questions thoroughly in Word document and attach to this application form. (500 words or less for each question) 1. What are your interests in the field? Please include relevant work/internship, leadership and/or academic experience. 2. What will you contribute to our team? What do you hope to gain through your participation in our Psychiatry Summer Training and Research Program (P-STAR)? Application Deadline is Friday, February 8th, 2013 at 5pm. Applications are not considered complete until application form, recommendation letter, resume, and official transcripts have been received. (Official transcripts must be mailed to the address below from your school directly.) PLEASE e-mail all documents other than your official transcript by email to JHSZC@jhmi.edu. Applications and supporting documentation may be mailed to the following address by February 4, 2013 (postmarked date): Department of Psychiatry and Behavioral Sciences The Johns Hopkins University School of Medicine Attn: P-STAR Committee 600 North Wolfe Street / Meyer 3-166 Baltimore, Maryland 21287-7364 You will be notified of the decision by the end of March. Questions or comments? Please email JHSZC@jhmi.edu.
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