PhD Application - The Roskamp Institute

Application

Applicants for the program will be required to complete the following application form and submit to the Roskamp Institute Ph.D. Program Administrator who will screen for eligibility.

Eligible applications will be reviewed by the Roskamp Institute Admissions Commit tee, and competitive applications will be selected for interview in person or by tele/video conference.

Admission Requirements

A prospective candidate must have:

For UK students a Bachelor’s degree of class 2.1 or higher in a biological sciences field.
For US students a Master’s degree in a biological sciences field or a Bachelor’s degree
Plus:
- Either one year of post-graduate full-time laboratory research at the Roskamp OR
- Two years of post-graduate full-time laboratory research with another institution and
  demonstrated productivity.
For students from other countries equivalency to either UK or US student requirements as stated above

Personal Information

First Name

Last / Family Name

Email

Country of Citizenship

Current Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Permanent Address (if different from above)

Address Line 1

Address Line 2

City

State

Zip Code

Country

Home Phone

Work Phone

Cell Phone

For US phone numbers, please use the following format: "(area code) phone number"

For all other countries, please use: "+country code (area code) phone number"

Sex

Male

Female

Prefer not to say

Date of Birth (Day/Month/Year)

Education:

Please list beginning with most recent

Degree

Major Subject

Describe Other

Minor (if applicable)

College/University

Year Started

Status

Year Finished

Area of Specialization

GPA

Degree

Major Subject

Describe Other

Minor (if applicable)

College/University

Year Started

Status

Year Finished

Area of Specialization

GPA

Degree

Major Subject

Describe Other

Minor (if applicable)

College/University

Year Started

Status

Year Earned

Area of Specialization

GPA

Have you been or are you currently enrolled in a PhD program?

Yes

No

Major Subject

Minor (if applicable)

College/University

Year Started

Status

Year Earned

Reason for program change or project abandonment:

Language

First/Native Language

Additional Language

Fluency (Select all that apply)

Additional Language

Fluency (Select all that apply)

Additional Language

Fluency (Select all that apply)

Additional Language

Fluency (Select all that apply)

TOEFL Score (if relevant)

Work History

Are you currently employed?

Yes

No

Company

Position

Division

Since

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone Number

Duties and Responsibilites

Previous Employment

Number of Previous Positions

Most Recent Employment

Please list beginning with most recent

Company

Position

Division

Period of Employment

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone Number

Duties and Responsibilites

Other Recent Employment

Company

Position

Division

Period of Employment

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone Number

Duties and Responsibilites

Laboratory Experience

Please describe relevant recent laboratory experience

Where

When

Description of Duties

Where

When

Description of Duties

Where

When

Description of Duties

Research Interests

Teaching Experience (if any)

Honors & Awards

List Applicable

Award Name	Date	Granting Agency/Institution	Brief Description

References

Professional References (please list 3)

Name	Company	Job Title	Relation	Email	Telephone

Publications

Most recent co-authored papers (if any)

Title	Publication Date	Brief Description

Other Information

Professional Affiliations

Relevant Hobbies (if any)

Narrative

Describe briefly your qualifications for the appointment you seek and why you should be considered for this program.

Narrative

I, , affirm the above information as accurate to the best of my knowledge.

In all aspects of its operations, The Roskamp Institute does not discriminate on the basis of age, race, nationality, ethnicity, religious preference, disability, sex, or gender.