2016/2017 MONTANA INBRE UNDERGRADUATE PUBLIC HEALTH INTERNSHIP

APPLICATION ***Use this application if you already have a MSU faculty mentor who has agreed

to work with you on an pre-defined public-health research project*** To be considered for this program you must:

• Be enrolled at Montana State University – Bozeman during the 2016-2017 academic year • Be a sophomore, junior, or senior during the 2016/2017 academic year • Be a US Citizen or authorized to work in the United States • Have a 2.5 GPA or better on a 4.0 scale (preferred, but some circumstantial exceptions made)

How to apply:

• Applications for fall semester & academic-year: due by 9:00am on September 12th, 2016 • Applications for summer internships: due by 9:00am on March 7th, 2017

The following materials are required; your application will not be screened until all are received.

• Completed & signed (or e-signed) application form (submit .pdf via email)• Two (2) letters of recommendation: At least one must be from your proposed project mentor.

The second may be from a current or former professor or from a former employer. • Current resume (.pdf)• One copy of transcripts for all post-secondary grades completed to date. An unofficial

transcript from your school's website or registrar is acceptable. (save & email .pdf)

Email complete application packages to:

Bill Stadwiser MT INBRE Program william.stadwiser@montana.edu

***Please note that implementation of this program is contingent upon continued funding of the MT INBRE grant.***

Email all documents in .pdf or Word format

2 of 6

MT INBRE PUBLIC HEALTH INTERN APPLICATION

Date:

Name: (first, MI, last,)

Permanent Address: (street, apartment number, city, state, zip code)

Permanent Telephone:

Preferred Telephone (if different from permanent)::

Current Address (if different than above): (street, apartment number, city, state, zip code)

Highest Degree Earned to Date (e.g High School, B.A):

Preferred E-Mail Address

Current Major/Curricular Program:

Briefly describe your current educational / career goals:

Total Credit Hours Completed to date:

Total Grade Point Average (GPA) to date:

Faculty Mentor Name (first, last):

Faculty Mentor College, Department, phone and email:

Please indicate the internship term you are applying for:

Full Academic year Summer term only

Are you able to work 10 hours per week during the internship term you selected?

Yes No

Year in School for 2016/17 academic year:

Sophomore

Junior

Senior Date undergraduate degree expected:

List any computer programs with which you are skilled:

Do you have any skills with research data analysis? Yes No If so, please describe:

Do you speak, write, and read English fluently? Yes No If no, please explain:

Do you speak, write or read any other languages? Yes No Please indicate language(s) and proficiency level:

3 of 6

Your Name:

Project Title:

Project Summary (250 words or less):

4 of 6

ADDITIONAL DOCUMENTS & NOTIFICATIONS:

Project Description: Please include a 3-5 page project proposal with your application. Your proposal should include a complete description of your project goals, methods, timeline, and plan for working with your mentor. Optional Personal Statement: Consider attaching a 1-2 page personal statement detailing why the MT INBRE selection committee should award funding to your project and how this funding will contribute to your academic or professional career. For students with a GPA below 2.5 on a 4.0 scale, this section is an opportunity to explain any extenuating circumstances or relevant information pertaining to your current and potential level of academic achievement. Notice of Institutional Review Some types of research and creative projects involve sensitive activities that may require permits and/or approval from the Institutional Review Board or other committee. If your project is selected for funding, you will be responsible for working with your faculty mentor to acquire appropriate institutional approvals in a timely manner. Notice of Responsible Conduct of Research Researchers and interns are responsible for conducting research in an ethical manner according to the standards of their discipline. Montana INBRE is federally funded, and federal law requires all researchers receiving federal funds to be trained in the responsible conduct of research (RCR). We require that all undergraduate public health interns to obtain general training through the online CITI course. There is no need to obtain this training as part of your application, but please note that, if your internship project is selected for funding, we require that you obtain certification through a designated CITI course. Notice of Background Check Please note that some applicants may be subject to a background check depending on the nature of the internship.

5 of 6

Name (again):

CHECKLIST A complete application will contain these materials:

This Application Form

3-5 Page Project Description

Transcript(s). Unofficial copies are acceptable

Current Resume

Two (2) letters of recommendation. (one needs to

be from your proposed project mentor)

Optional Personal Statement

How did you hear about the INBRE Internship Program?

INBRE Website

Professor or Academic Department (please specify)

Another student

College Career Center

Flier or poster

Other: Please specify

CERTIFICATION AND SIGNATURE By submitting my application I certify that all statements contained herein are true and complete, and this section is enforceable as if I had signed below. If my internship project is selected for INBRE funding, I commit to obtaining in a timely manner all IRB approval(s) and RCR certification(s) deemed necessary by Montana INBRE program staff. If my project involves working with vulnerable or at-risk populations, I am aware that funding may be contingent on successfully completing a background check. Please e-sign or type your name and date: Applicant Signature:

Date: