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 (firstname.lastname@example.org).
First name: _______________________ Last name: __________________________________
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.
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