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Also known as your surname or family name.
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Demographic Information
Collecting demographic information is required to support our NIH Training Grant 5T32HL076139-19.
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Ethnicity
Do you consider yourself to be Hispanic or Latino?
Hispanic or Latino is a person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race. The term "Spanish origin," can be used in addition to "Hispanic or Latino."
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Select One *
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Race
What is your racial background?
American Indian or Alaska Native is a person having origins in any of the original peoples of North, Central, or South America, and who maintains tribal affiliation or community attachment.
Asian is a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Black or African American is a person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black" or African American."
Native Hawaiian or Other Pacific Islander is a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White is a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
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Select all that apply *
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Americans with Disabilities Act
Disability: A physical or mental impairment that substantially limits one or more major life activities, as described in the Americans with Disabilities Act of 1990, as amended.
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Do you have a disability? *
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The question below applies to determining disadvantaged status. For information about each item please see the Helpful Links section immediately following this question. Please check the box next to each situation that applies to you: *
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Helpful Links
McKinney-Vento Homeless Assistance Act https://nche.ed.gov/mckinney-vento-definition/
Administration for Children and Families
https://www.acf.hhs.gov/cb/focus-areas/foster-care
Federal Free and Reduced Lunch Program
https://www.fns.usda.gov/school-meals/income-eligibility-guidelines
Federal Pell grants
https://www2.ed.gov/programs/fpg/eligibility.html
Rural Health Grants Eligibility Analyzer
https://data.hrsa.gov/tools/rural-health
Centers for Medicare and Medicaid Services-designated Low-Income and Health Professional Shortage Areas
https://www.qhpcertification.cms.gov/s/LowIncomeandHPSAZipCodeListingPY2020.xlsx?v=1
Persons in family or household / Income Level at or below
1 / $16,090
2 / $21,770
3 / $27,450
4 / $33,130
5 / $38,810
6 / $44,490
7 / $50,170
8 / $55,850
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Citizenship and Immigration Status
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Please check one *
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Referee & Transcripts Information.
Please enter the names of 2 teachers or guidance councilors that we can obtain a letter of recommendation for you from. Please also enter the name and email of a school representative that we can contact to obtain your most recent transcripts from.
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School Information
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Required for all high school students and anyone under the age of 18.
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Have you participated in the Pulmonary and Critical Care Summer Research Program or the Kimberly Querrey Summer Research Program previously? *
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Do you have an interest in Computational Biology? *
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Attachments - Required for all applicants.
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Two letters of recommendation from teachers, mentors, or advisors will needed to complete your application. Your most recent transcripts are also required. Please have your letters and transcripts sent to PULMSRP@northwestern.edu with your name in the subject line. We cannot accept letters and transcripts submitted by the applicant. This is not required if you were previously accepted into the program and are applying for your second year. *
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The Kimberly Querrey Summer Research Program does not provide or recommend housing. Interns are responsible for obtaining and paying their own housing costs.
The Kimberly Querrey Summer Research Program does not provide or pay for parking or other transportation costs. Interns are responsible for getting themselves to and from the downtown Chicago campus. *
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All participants in the Kimberly Querrey Summer Research Program must be fully vaccinated against COVID-19. If you are selected to participate in the program you will be asked to provide proof of vaccination. *
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