SRI 2024 Application

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Personal Information
Name Name First Last
Panther ID (if none, write none)
Last 4 Digits of SS#
Must be 4 characters. Currently Entered: 0 characters.
Student's Email
Sex (Please type)
Please select your High School graduation year

Please select your High School graduation year 2024 2025
Please type in your current school's name
Ethnicity (you may select more than one)

Ethnicity (you may select more than one) Alaska Native American Indian Asian Black Hispanic Pacific Islander White Other Other
Will you be a first generation college student?

Will you be a first generation college student? Yes No
Have you applied to Florida International University?

Have you applied to Florida International University? Yes No I plan to
Have you been accepted to Florida International University?

Have you been accepted to Florida International University? Yes No I have not heard back I did not apply
Will you be enrolled in classes at Florida International University during Summer 2024?

Will you be enrolled in classes at Florida International University during Summer 2024? Yes No I was accepted to FIU for Summer 2024, but I am not sure I will be enrolled. I have not heard back
Will you be enrolled in classes at Florida International University during Fall 2024?

Will you be enrolled in classes at Florida International University during Fall 2024? Yes No I was accepted to FIU for Fall 2024, but I am not sure I will attend. I have not heard back
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent/Guardian & Emergency Contact Information
Parent/Guardian Name Parent/Guardian Name First Last
Parent/ Guardian Address Parent/ Guardian Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent/Guardian Phone Parent/Guardian Phone - ### - ### ####
Parent/Guardian Email
Relationship to Student
Uploads
Please upload a copy of your most recent report card

Attach Files

PDF only
Please upload a Personal Statement
Each applicant must submit a one-page essay detailing why you want to join the internship program and any research areas of interest you have. This may or may not have to do with cardiovascular research. (We want to get an idea of your interests). Please include your name, email, and current institution at the top of the page, use Arial 11-point font, and use 1-inch margins. Remember to include your name on the document.

Neglecting to follow these directions will eliminate you from the applicant pool.

Attach Files
Will you be 18 years or older on June 17?

Will you be 18 years or older on June 17? Yes No
Please upload the Medical Authorization Form (if you are under 18 years of age on June 17), which can be found here: https://generalcounsel.fiu.edu/wp-content/uploads/sites/20/2019/03/Medical-Authorization-Form-for-Minors-FIU-or-Co-Sponsor-Event.pdf

Attach Files
Please upload the Release and Assumption of Risk Agreement Form (if under 18 years of age on June 17), which can be found here https://generalcounsel.fiu.edu/wp-content/uploads/sites/20/2021/05/Release-Waiver-of-Liability-and-Assumption-of-Risk-Minors-Internal.pdf

Attach Files
Please upload the Photographic-Film Consent and Release Form (if under 18 years of age on June 17), which can be found here https://generalcounsel.fiu.edu/wp-content/uploads/sites/20/2021/03/Photographic-Film-Consent-and-Release-Minors.pdf

Attach Files
Please upload the Photographic-Film Consent and Release Form (if you are 18 years of age or older on June 17), which can be found here https://generalcounsel.fiu.edu/wp-content/uploads/sites/20/2019/09/Photographic-Film-Consent-and-Release-Form-Adults-1.pdf

Attach Files
Please upload the Volunteer Form A (if you are under 18 years old), which can be found here https://hr.fiu.edu/wp-content/uploads/2023/07/Updated-Volunteer-application-A-7.2023.pdf

Attach Files
Please upload the Intern Form A (if you are over 18 years old) which can be found here https://hr.fiu.edu/wp-content/uploads/2023/07/Updated-Intern-application-A-7.2023.pdf

Attach Files
Letters of Recommendation

This is the description of your section break.
Recommender 1 Recommender 1 First Last
Recommender 1 Email
Recommender 2 Recommender 2 First Last
Recommender 2 Email

SRI 2024 Application

SRI 2024 Application

Personal Information

Parent/Guardian & Emergency Contact Information

Uploads

Letters of Recommendation