STAR Program Application

Specialty Training and Advanced Research

UCLA School of Medicine

Name:

Address:

Phone: e-mail:

Pager: SS#: - -

 United States Citizen  Permanent Resident  Visa- Status:

College:

Medical School:

Internship:

Residency:

Fellowship:

I am applying for a

 Clinical Fellowship in

 Clinical Residency in

And a combined research program (select one of the following)

 Ph.D. Degree in

 Postdoctoral Fellowship( for those entering with M.D./Ph.D.) in

 Master of Science in Clinical Research __________________________________________

Þ Please Submit the Following:

1) PERSONAL STATEMENT: Summarize your research accomplishments. Indicate the clinical and research areas you wish to pursue in the STAR program. Discuss the basis of your interest and the role you expect research to have in your long-term career. Describe your plan of study in research (Please include possible mentors, research departments, if known) What do you want to accomplish in the Star Program? Limit 3 pages, size 10 font

2) CURRICULAM VITAE: Please include research experience.

3) LETTERS OF RECOMMENDATION: In addition to the letters you will be sending for consideration in a clinical program, you are required to send at least one letter from a research mentor. This letter should evaluate your performance potential as a researcher. The letters are mailed separately by your evaluators.

4) TRANSCRIPTS: Graduate, Medical, and Undergraduate. Photocopies of transcripts are acceptable.

SCORES: GRE, MCAT, USMLE, or other applicable scores. Photocopies of scores are acceptable

5) REPRINTS OF PUBLICATIONS: Photocopies of reprints are acceptable

I certify that the information in this application is true and correct to the best of my knowledge.

Signature: Date:

Incomplete applications will not be reviewed. Interviews are scheduled by invitation only.

Please refer to Division/Department deadlines when submitting applications.

Returning the Application:

1) If you are applying for clinical subspecialty training within the Department of Medicine, please return your application to the specific division.

2) If you are applying to a department outside of the Department of Medicine, please return your application to :

STAR PROGRAM OFFICE 10833 Le Conte Ave., Rm 32-115 CHS Los Angeles CA 90095-1736

STAR Program 310-206-4632 http://www.star.med.ucla.edu/