Charles Drew University of Medicine And Science - Division of Cancer Research And Training
Application for Undergraduate Program

 General Information


*Last Name :   *First Name : Middle Initials :


Address :


City : State : Zip :


*Telephone : *E-mail :
* Date of Birth : * Age : * Sex : *Social Security Number :
  (mm/dd/yyyy)         (last 4 digits 000-00-XXXX)


Please choose one of the following categories which you identify with the most :


If other, please specify :


 Health Insurance


 Do you have health insurance? Please note that this will not affect your acceptance in any way.          


           If so, will you be able to provide a copy of your insurance card upon acceptance?          


 Program Dates


 We have two program schedules to accommodate students on either the quarter or semester system. Please choose the program track you will be able to commit to for the entire 12 weeks.


1. Semester System Track
Program Dates:

May 21, 2018- August 10, 2018

2. Quarter System Track
Program Dates:

June 18, 2018- September 7, 2018

 Educational Background
Beginning with the institution you are currently attending, please list the colleges, universities, and high school you have attended


Name of School/Location (City/State)   Major/Expected Degree Expected Graduation Date (Month/Year) Overall GPA


Current year in college :              


 Extra Curricular Acitivities
Please list activities and provide a brief description.


Acitvity  Description



 Employment Information/Work Experience
Please list all work experience, including non-research related.


Company Name   Dates of Employment Title/Position





Recommender 1:


Name :   Title :
Institution : Telephone Number : (xxx-xxx-xxxx)
E-mail : Date asked for letter :


Recommender 2:


Name :   Title :
Institution : Telephone : (xxx-xxx-xxxx)
E-mail : Date asked for letter :


 Official Transcripts
Please mail the official transcript to:   Milena Pavlova, Division of Cancer Research & Training
Charles R. Drew University of Medicine and Science
1731 E 120th St, Los Angeles, CA 90059
 Short Answer Questions
Please answer the following questions in the area provided.


1. What are your hobbies or main interests outside of school ?


2. What other summer programs are you applying to ?


3. What are your long term education and career objectives ?                               Choose one of the following : 


4. Briefly describe any independent study or projects that you have completed.


5. What are your research interests?


 Essay Question
Please use the limited space below to answer your essay question.


*What are your expectations of the Charles Drew University- Division of Cancer Research and Training Undergraduate Cancer Research Training Program and what do you hope to gain from your participation in the program? How will it help you achieve your academic and career objectives stated in the short answer portion?



I hereby certify that the above information provided on this application is correct to the best of my knowledge.

*Signature :           *Date :
How did you hear about UCRTP ?


For any questions, please contact Milena Pavlova by phone (323) 563-4853 or email: