Basic InformationName(Required) First Last Date of Birth(Required) Month Day Year Gender Pronouns(Required)Examples: she/her, they/them, he/him, etc.Email(Required) Phone(Required)Format: (XXX) XXX-XXXXPreferred NameIf different than your given name.Current Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Permanent Address (if applicable) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How did you hear about this internship?(Required) Google Search Campus Career Services Professor Academic Advisor Other EducationName of the educational institution you are currently attending or recently graduated from?(Required)What type of educational institution is it?(Required) Public Private HBCU Other When does your school year end for summer? Month Day Year Answer if you are in school.When does school start for the new school year? Month Day Year Answer if you are in school.Graduation Date(Required) Month Day Year Please enter your anticipated graduation date if you have not yet graduated.Are you available for the entire duration of the summer program?(Required) Yes No The program runs from June 9th – August 15.What is your academic standing?(Required) Freshman Sophomore Junior Senior Community College Student, getting ready to transfer Recent Graduate Other Resume(Required)Accepted file types: pdf, Max. file size: 10 MB.Please upload in .pdf formatAcademic Transcript(Required)Accepted file types: pdf, Max. file size: 10 MB.Please upload in .pdf format.Additional Transcripts Drop files here or Select files Accepted file types: pdf, Max. file size: 10 MB. Please upload in .pdf formatPrimary Reference: Professional ReferenceYour primary reference must be a professional reference who can provide insights into your work ethic and skills (Ex: Direct supervisor, Professor, Academic advisor). This reference will be required to complete a recommendation form, which is a required step to be considered for the program. Please provide their information below and ask them to fill out this recommendation form. The person giving the recommendations must email it to [email protected]. We will not accept recommendation forms submitted by applicants. All recommendations will be verified by SHARP staff.Name of Primary Reference(Required) First Last Primary Reference's Email Address(Required) Please provide their professional email (e.g. an email ending in .edu)Primary Reference's Phone Number(Required)Primary Reference's Relationship to You(Required)Please specify whether they are your professor, supervisor (from which job), advisor (from which program), etc.Secondary Reference: Professional or Personal ReferenceYour secondary reference can be either a professional or personal reference (Ex: Mentor, Community leader, volunteer supervisor). This reference should be able to speak to your character, personal qualities, and any relevant attributes that would contribute to your suitability for the position/program. Note: SHARP staff may contact your references via phone for additional questions.Name of Secondary Reference(Required) First Last Secondary Reference's Email Address(Required) Please provide their professional email (e.g. an email ending in .edu)Secondary Reference's Phone Number(Required)Secondary Reference's Relationship to You(Required)Please specify whether they are your professor, supervisor (from which job), advisor (from which program), etc.Personal Statement #1 (Maximum of 800 words)Please provide a statement that describes the following: Your academic and career goals; What has inspired you to pursue these goals (e.g., personal/life experiences, community involvement, volunteer experience, previous experience conducting research, etc.); How this program will help you reach your goals; and Any unique, personally important, and/or challenging factors in your background that have influenced your goals or your academic achievements. Statement #1(Required)Accepted file types: pdf, Max. file size: 10 MB.Please upload in .pdf formatPersonal Statement #2 (Maximum of 400 words)Choose your top 3 content areas that you are most interested in learning about while in SHARP. Pick at least one content area that you select and discuss why it interests you.Content Areas of Interest (choose 3)(Required) Underserved communities Public health leadership Quantitative data analysis (Epidemiology) Qualitative research (interviews/focus group data) Scientific writing Health disparities Substance Use Food security Graduate or medical school Professional development Other Several ideas are listed, but you should also feel free to add your own by selecting “Other”.Other Areas of Interest(Required) Add RemoveStatement #2(Required)Accepted file types: pdf, Max. file size: 10 MB.Please upload in .pdf formatDemographicsThank you for your interest in SHARP. As a program supported by the National Institutes of Health (NIH) to enhance the diversity of the biomedical, behavioral and clinical research workforce, we are committed to understanding more about the demographics of our applicants. It will not be used during the selection process, but rather will allow us to report to NIH about the diversity in our applicant pool, and will help us in an ongoing way to improve our recruitment efforts.What is your current educational status?(Required) I am enrolled in a community college certificate or associate’s degree program I am a first-year college undergraduate. I am a first-year college undergraduate. I am a third-year college undergraduate. I am a fourth-year college undergraduate. I am a recent graduate. I am a post-baccalaureate student. I am a graduate or medical student. Other Did you declare a major or concentration yet?(Required) Yes No What major or concentration have you declared?(Required)Please include double majors, concentrations, etc.Please choose the one statement below that comes closest to your current academic goal:(Required) My goal is to go to graduate school for a Ph.D. or other doctorate degree in a biology-related field (e.g., biology, microbiology, physiology, molecular biology, biophysics). My goal is to go to graduate school for a masters degree in a biology-related field (e.g., biology, microbiology, physiology, molecular biology, biophysics). My goal is to go to graduate school for a Ph.D. or other doctorate degree in the physical sciences (including engineering, math, physics, chemistry, and computer science). My goal is to go to graduate school for a masters degree in the physical sciences (including engineering, math, physics, chemistry, and computer science). My goal is to go to graduate school for a Ph.D. or other doctorate degree in a social science (including psychology, sociology, anthropology, economics, and political science). My goal is to go to graduate school for a masters degree in a social science (including psychology, sociology, anthropology, economics, and political science). My goal is to go to graduate school for a masters degree in Public Health (M.P.H.). My goal is to go to graduate school for a doctorate degree in Public Health (Dr.P.H.). My goal is to go to graduate school for a masters or a Ph.D. in humanities or fine arts. My goal is earn a certification or degree that will qualify me for teaching. My goal is to go to school for a medical degree (M.D.). My goal is to go to school for an M.D./Ph.D. My goal is to go to school for other health professions. My goal is to go to a type of graduate or professional education not mentioned above, such as law school, business school, architecture, etc. My goal does not include graduate education for at least the near future. Unsure This question is about your goals beyond your undergraduate degree. It is difficult to list all the goals people may have. The purpose of this question is to learn how many students plan to go on in science, medicine, or other fields, as well as to learn how many students do not plan to go to post-graduate education in their near future.To what extent would you say your career path is clear?(Required) Very clear Somewhat unclear Neither clear nor unclear Somewhat clear Very clear How would you rate your self-confidence to pursue academic work in the future (e.g. developing a research study to answer a scientific question, writing journal articles, etc.)?(Required) Very low Somewhat low Neither low nor high Somewhat high Very high Which of the following racial categories best describes you?(Required) Black or African American Asian Native Hawaiian or Other Pacific Islander Native American Hispanic or Latino/a/x White Multi-ethnic Prefer not to answer Other What is your gender?(Required) Male Female Trans Male Trans Female Genderqueer/Gender Non-binary Prefer not to Answer Other How do you describe your sexual orientation or sexual identity?(Required) Straight/Heterosexual Bisexual Gay / Lesbian / Same-Gender Loving Questioning / Unsure Prefer not to answer Other Do you come from a family with an annual income below established low-income thresholds?(Required) Yes No Don’t Know Prefer not to answer Review low-income thresholds at https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelinesDo you come from a social, cultural, or educational environment, such as one found in certain rural or inner-city environments that directly inhibited you from obtaining the knowledge, skills, and abilities necessary to develop and participate in a research career?(Required) Yes No Don’t Know Prefer not to answer Do you consider yourself to have any physical or mental disabilities?(Required) Yes No Don’t Know Prefer not to answer A disability is defined as a physical or mental impairment that substantially limits one or more major life activities. Please list any additional languages you speak and your proficiency level in each.LanaguageProficiency Level Add RemovePhoneThis field is for validation purposes and should be left unchanged.
