Application Deadline: April 5, 2013 by 3 PM: What Is The Purpose of The CURE Project?

Application Deadline: April 5, 2013 by 3 PM
What is the purpose of the CURE Project? The Ted R. Lilley Continuing Umbrella of Research Education (CURE) Intern Program is a research mentorship training program supported by the OHSU Knight Cancer Institute and the OHSU Center for Diversity and Inclusion. It is designed to offer research experiences to students from the Portland area that excel academically and come from socially and economically disadvantaged background. The goals of this program are to give hands-on research experience, science exposure and to increase participation of underserved and minority students in biomedical research and other healthrelated fields. What is expected of students during the program? Students work full time for 10 weeks in a cancer lab with a Knight Cancer Institute Member between the end of the school year and the beginning of the next academic year (late June August). Each student is required to attend weekly seminars and classes, as well as adhering to the curriculum set by their college level mentor. The program culminates with a poster presentation attended by the lab employees, directors and additional staff of the Knight Cancer Institute at the end of the program. Eligibility Requirements: Current sophomores and juniors from Oregon High Schools (preference for selection given to Public Schools) belonging to a group that is historically underrepresented or socially and economically disadvantaged are eligible for application and consideration. (Please see below definitions) Must be 16 or older by June 13th, 2012 All students must also have a 3.5 GPA or higher to be eligible for this program and have taken at least one science class, preferably biology. Definitions: Economically disadvantaged is defined as individuals who come from a low income family, using low-income levels as a specified by the U.S. Department of Health and Human Services. Socially disadvantaged means students coming from an environment that may inhibit them from obtaining knowledge, skills or abilities in pursuit of education in a health field. This includes, but is not restricted to, students whose parents did not

attend or complete college; and/or students being reared by a single or divorced parent. Underrepresented students belong to groups that are recognized as historically underrepresented in the health and science professions including: AfricanAmerican/Black, Native American/Alaskan Native, Pacific Islander and Hispanics/Latinos.
Check List
Students submit a completed application packet to the below address, including the following materials in the order they appear below: 1. Check List (please check off all items that are included in your packet and make the checklist the first page of your application.) 2. The Application pages 1, 2, and 3. 3. A signed application form by the student and parent(s)/Guardians. 4. A 1000 word essay written by the student indicating his/her career goals, activities, intellectual interests, future educational plans, and the reason the student would like to participate in this program. 5. One - Teacher letter of recommendation. 6. One - Professional recommendation from a teacher, counselor, and/or past employer. 7. One copy of an official academic transcript.

c/o Jennifer Teeples, OHSU Knight Cancer Institute 3181 SW Sam Jackson Park Road, Mail Code CR145 Portland, OR 97239
Frequently asked questions: Is this a paid internship? Yes Will I be able to utilize the OHSU academic advisors to help me choose and apply for college and scholarships after I graduate? Yes If I submit more than one teacher and professional recommendation will it increase my chances of getting into the program? No Should I fill this application by hand or type in all my information using a computer? You can fill this application out either way. Please Send Completed Packet to:

Do you have more questions? Contact: Jennifer Teeples,
([email protected])
CURE
Coordinator
at
503.494.8382
or
email
Note: The Program reserves the right to terminate students from the program at any time for misconduct or non-compliance with OHSU policies and procedures.
Application Form -- page 1

PART I: To be completed by student, please feel free to add extra paper if you need more room.
Please list academic activities below:

School (clubs, government, sports, etc.)
Please indicate all academic awards:
Special talents or interests
Application Form -- page 2

PART II: To be completed by student Last Name: ___________________________________________ First Name: _____________________ Address: _____________________________________________________________________________ City: _________________________________ State: _____________ Zip code: _________________ Telephone: ____________________________ Birthdate: ______________________ Ethnic Background:___ (1) African American ___ (2) Native American Tribe: ________________________________ (specify) E-mail Address: _______________________________
___ (3) Asian American / Pacific Islander _________________________ (specify) ___ (4) Hispanic / Latino ___ (5) Caucasian ___ (6) other Are you a U.S. citizen? Yes No Yes No ______________________________________ (specify) ______________________________________ (specify)
If not a U.S. citizen, are you a permanent resident?
Name of High School: ________________________________________ In the fall, will you be a sophomore or a junior? Sophomore Junior
Teacher Name: ________________________________________ Telephone: _____________________ Address: ______________________________________________________________________________ Professional Name: _____________________________________ Telephone: _____________________ Address: ______________________________________________________________________________
I hereby certify that I understand the above guidelines and that the information given in this application is true to the best of my knowledge.
Student Signature: ________________________________________________ Date: ________________ (See next page for Part II to be completed by parent or guardian)
Application Deadline: April 5, 2013 by 3 PM Application Form --- page 3

Part III: To be completed by parent or guardian 1. Parent status: Married ______________________ 2. Parent Information: A. Mother - Name: __________________________________________ Phone: ___________________________
Address: __________________________________________________________________________________ Occupation: ______________________________________ Years of school completed: __________________
Divorced
Single Parent
Other
B. Father - Name: ___________________________________________ Phone: __________________________

Address: __________________________________________________________________________________ Occupation: _____________________________________ Years of school completed: __________________
C. Guardian (If Applicable) - Name: _____________________________________ Phone: __________________

Address: __________________________________________________________________________________ Occupation: _____________________________________ Years of school completed: __________________
3. How many people currently live in family household? ___________
Adults ___________ Children
4. Have any of your children ever gone to college or vocational school? College: Yes (____ yrs) No Vocational: Yes ( ____ yrs) No
5. Number of dependents listed on 20011 Federal Tax Form: _________ 6. Family Adjusted Gross Income from 20011 Federal Tax Form: ________________________
I hereby certify that all statements made in this application are true to the best of my knowledge.
Parent or Guardian Signature: ______________________________________ Date: ________________
PART IV: To be completed by a Teacher
Teacher Recommendation Form

Name of student applicant: _________________________________________________ Please prepare a letter on a separate piece of paper that answers these questions: 1. What is your relationship to this student and how well do you know the applicant? 2. What is this students potential for success in the Ted R. Lilley Cancer CURE Program, considering his/her motivation, initiative, creativity, scientific aptitude, intellectual abilities, work ethic, ability to work independently, and any other qualities that would make him/her well suited to cancer research? 3. Please give the letter and this form to the student to include with his/her application. Name of Teacher: ________________________________________________________ Address: _______________________________________________________________ Phone: _______________________ E-mail Address: ___________________________ The Ted R. Lilley Cancer CURE Project is sponsored by the Knight Cancer Institute at Oregon Health and Sciences University and the OHSU Center for Diversity and Multicultural Affairs for disadvantaged high school juniors interested in pursuing college majors and careers in the biological sciences and health care professions. The goals of this program are to give hands-on research experience and science exposure to disadvantaged students in biomedical research and other healthrelated programs. Selected students will work in research laboratories under the auspices of OHSU scientists conducting cancer research for a minimum of 10 weeks. They are expected to read scientific literature in cancer research and attend special seminars highlighting various areas of biomedical research. Please return this form to the Knight Cancer Institute as part of the 2013 Ted R. Lilley Cancer CURE application packet.
Attention: Jennifer Teeples | CURE Coordinator Oregon Health & Science University Knight Cancer Institute

3181 SW Sam Jackson Park Road, CR145| Portland OR 97239 503.494.8382 | fax 503.494.7086 | [email protected]
PART V: To be completed by a teacher, mentor, employer, or other valid professional.
Professional Recommendation Form

Name of student applicant: _________________________________________________ Please prepare a letter on a separate piece of paper that answers these questions: 1. What is your relationship to this student and how well do you know the applicant? 2. What is this students potential for success in the CURE Project, considering his/her motivation, initiative, creativity, scientific aptitude, intellectual abilities, work ethic, ability to work independently, and any other qualities that would make him/her well suited to cancer research? 3. Please give the letter and this form to the student to include with his/her application. Name of Teacher: ________________________________________________________ Address: _______________________________________________________________ Phone: _______________________ E-mail Address: ___________________________ The CURE Project is sponsored by the OHSU Knight Cancer Institute and the Center for Diversity and Multicultural Affairs for disadvantaged high school juniors interested in pursuing college majors and careers in the biological sciences and health care professions. The goals of this program are to give hands-on research experience and science exposure to disadvantaged students in biomedical research and other health-related programs. Selected students will work in research laboratories under the auspices of OHSU scientists conducting cancer research for a minimum of 10 weeks. They are expected to read scientific literature in cancer research and attend special seminars highlighting various areas of biomedical research.

Please return this form to the Knight Cancer Institute as part of the 2013 Ted R. Lilley Cancer CURE application packet.
Attention: Jennifer Teeples | CURE Coordinator Oregon Health & Science University Knight Cancer Institute 3181 SW Sam Jackson Park Road, CR145| Portland OR 97239 503.494.8382 | fax 503.494.7086 | [email protected]

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