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					2009-10 NIH Biotechnology Training Program Application

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Cover Page
2009-10 Application for Support NIH Biotechnology Training Program (2 T32 GM08799)

Student Name (Nominee)

Phone ______________________________ Email ______________________________ DEB member: YES_____ NO_____ US Citizen YES ____ NO _____ Permanent Visa Resident in US YES______ NO______ YES _____ No ______

URM (Underrepresented Minority) Gender:

Male_____ Female_____

Graduate Group/Program PhD Program Entry Date ______________________ Preceptor (Nominator)

Department

Phone

Email

Research Project Title

Signature

Date

Please submit cover page, application forms and letter of recommendation by faculty preceptor to the Biotechnology Program office in 0301 Life Sciences by 5PM on Wednesday, April 22, 2009. If you have any questions, please contact Dr. Judith Kjelstrom at jakjelstrom@ucdavis.edu or 752-8228 or 752-3260 (main desk).

2009-10 NIH Biotechnology Training Program Application

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2009-10 APPLICATION FOR SUPPORT BY THE BIOTECHNOLOGY TRAINING FELLOWSHIP

1. NAME____________________________________ 2. DEPARTMENT____________________________ 3. GRADUATE PROGRAM______________________4. PRECEPTOR_______________________________ 5. PHONE NO._______________________________ 6. MONTH & YEAR ENTERED GRADUATE SCHOOL AT UC DAVIS_____________________ 7. US CITIZENS OR GREEN CARD HOLDER ______8. EMAIL: ___________________________________ 9. RESEARCH PROJECT (Title)_______________________________________________________________ 10. RESEARCH PROJECT: Describe briefly your research project and objectives using the “first person case” to indicate your work. This description should fit in the space provided below. This description may be used in an actual T.G. application or progress report, so compose it with care. Underline up to 10 key words. USE ONLY A FONT SIZE OF 11-12 POINT – APPLICATION WILL NOT BE ACCEPTED WITH SMALLER FONT SIZE! ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________

2009-10 NIH Biotechnology Training Program Application
Application for Trainee Support (Continued) ONLY FONT SIZE OF 11-12 POINT ACCEPTED!

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11. Briefly describe your research progress. Your description should fit in the space provided below. (Include all relevant information.) Include your publications, abstracts, manuscripts in preparation on page 4. ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 12. Briefly outline why you consider that you should be supported by a Biotechnology Training Fellowship. ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________

2009-10 NIH Biotechnology Training Program Application
Application for Trainee Support (Continued) ONLY FONT SIZE OF 11-12 POINT ACCEPTED!

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13. Please include publications, abstract, manuscripts in preparations below. ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 14. I am willing to commit to a minimum of three months training at one of the participating companies. Denote preference with an X (Agilent____, Amgen____, Amyris Technologies____, BioMarin Pharmaceuticals____, Genentech____, Monsanto-Calgene___, Novartis___, Novozymes____,)

2009-10 NIH Biotechnology Training Program Application CURRENT PREDOCTORAL STUDENT OF A DEB TRAINING FACULTY DATA SHEET

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Example:
Student Name Undergrad Degree Year & Institution GRE Scores V% - A% -Writing Subject exam % if taken 90% - 89% - 5.5 Biology -75% Undergrad GPA (based on 4.0) 3.79 Graduate GPA Year Entered Preceptor Graduate Group For Renewals: Yrs Supported by Fellowship

John Doe

BS Biochem 1999, UC Davis

3.8

1999

Hammock

Entomology

N/A

2009-2010 Nominee:
Student Name Undergrad Degree Year & Institution GRE Scores V% Q% A% Adv% Undergrad GPA Graduate GPA Year Entered Preceptor Graduate Group For Renewals Yrs Supported by Biotech Fellowship