2019 Future Scientist Program Invitation

Thank you for your interest in the IU Simon Cancer Center 2019 Future Scientist Program . Please provide answers as accurately and completely as possible. After completing this invitation you will then receive additional application links. To receive a confirmation for this email, please be sure to enter your email again after you click submit.

Last Name, First Name

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If you have a school issued email, enter your school email here.

What is your personal email where we can write you to follow up on your application?

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Your email again

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Phone number where you are best reached?

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Name of Parent(s) or Guardian(s) that you live with. If you have a shared custodial arrangement, please add name/s of other custodial parents on the next line.

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Home Address. Enter your complete address here, with city, ST and zip)

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Address while at school. If you attend a school away from home, list your additional mailing address with city, ST and zip)

Name(s) of Additional Custodial Parents or Legal Guardians with shared custody.

Home phone number - or number where one of your parents can be reached

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Parent email 1. Provide an email address for the first parent you listed where we can send program information.

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Parent email 2. If available, provide an email address for the second parent listed.

Which high school do you attend? (it must be a public school in Marion County).

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Enter the Official Name of Your School Here

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Expected Graduation Year. PROGRAM ONLY ACCEPTS JUNIORS, CLASS OF 2020

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Date of Birth

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Gender

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Race

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Ethnicity

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How will you travel to your internship location this summer?

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How did you first learn of the Future Scientist Program?

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Who was the past intern? How do you know each other?

What is the name of the teacher who informed you about the Future Scientist Program?

Explain details of how you learned of the Future Scientist Program program

Enter your name on this line to certify you have completed this form with accurate information. After you click submit you need to provide your email for the system to send you the confirmation.

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