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Leal Lab

Houston, Texas

The Cullen Building at Baylor College of Medicine.
Molecular and Human Genetics - Center for Statistical Genetics
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Application for Advanced Gene Mapping Course

Please fill out this form to apply to the Advance Gene Mapping Course. Paste the filled-out form into the body of an e-mail. Please e-mail the additional material which is requested (see below) as an e-mail attachment. Submit the application to Katherine Montague (advancedgenemapping@gmail.com).

First name: _______________________ Last name: __________________________________

Affiliation: _____________________________________________________________________

Address: _____________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Work number: ___________________________________________________________________

FAX number:______________________ E-mail:________________________________________

Applying for fellowship: Yes __________ No _________

Please attach a copy of your curriculum vitae and a letter describing your experience with linkage analysis, genetic epidemiology, association studies and/or statistical genetics. If you are analyzing data for specific studies or developing methods please explain in your letter. If you are applying for a fellowship please also submit a letter of recommendation from your advisor or department head.

Please tell us about your research interest (e.g. Cardiovascular diseases, Bipolar, Schizophrenia, Method development in statistical genetics). This information will be included in the course list which will be distributed to all course participants.

_______________________________________________________________________________

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Optional Information
This course is supported by the NIH. They request that we provide the following information. It is appreciated if you would supply us with this optional information.

Gender: _____ Male ______ Female

Primary Appointment:_____ Academics______ Government______ Industry

Degrees:_____ MD_____ PhD_____ MS or MA_____ BS or BA____ Other

Ethnic Background: ____ American Indian or Alaskan Native _____ Asian or Pacific Islander

____ Black, not of Hispanic origin ____ Hispanic

____ White, not of Hispanic origin

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