Ecole Polytechnique Fédérale de Lausanne Swiss Federal ... - EPFL

Ecole Polytechnique Fédérale de LausanneSwiss Federal Institute of Technology LausanneApplication form for the Life SciencesInternational Summer Research Program 2010Please print clearly or type.Personal information1. Legal family name2. First name(s) 3. Sex M F4. Address where youcan be permanentlyreached (e.g. yourparents' address)PhoneFaxE-mail5. Current addressPhoneFaxE-mail6. Country of Citizenship7. Date of birth (DD/MM/YYYY)8. Place of birth (for Swiss citizens, place of citizenship)EPFL Application for Summer Research Program 2010

EPFL Application for Summer Research Program 2010 page 2Curriculum Vitae9. List all universities, colleges or other academic institutions attended including high school. Do not abbreviate names of institutions. Include in your applicationcertified transcripts, translated into English if not originally in French, German or English (including a scaling of the grading system at your university)Institution name and location Major field of study Dates attended Normal duration ofstudy *from toExpectedDegree *** towards this degree, full time and with no failures or interruptions

EPFL Application for Summer Research Program 2010 page 310. List academic honors, prizes and fellowships you have received11. List occupations, other than as a student, in which you have engaged to any considerable extent, givingnames and location of employers and dates of employment. Include military service or voluntary workexperience you have had.Occupation / responsibility Employer / location Time period12. Any other relevant information about yourself (hobbies, skills, interests,…)13. List of 2 referees to whom you have submitted the reference letter form1. NameAddress2. NameAddressEPFL Application for Summer Research Program 2010

Personal Statement (maximum 1000 words)14. Please give your reasons for wishing to participate in the EPFL Summer Research Program 2009. TheAdmission Committee will welcome any factors you wish to bring to its attention. (For example, youracademic background, scientific interests, long-term professional goals, any previous researchexperience and what you hope to accomplish from attending the summer research program.)15. Please list here your preferences of laboratories in which you would wish to work (in order of priorities)and explain your choices.I. Lab name:Reason:II. Lab name:Reason:III. Lab name:Reason:EPFL Application for Summer Research Program 2010

16. Please indicate how you heard about our program.Enclosures :• Official transcripts of diplomas and grades from all academic institutions of highereducation you have attended• Two letters of recommendation in sealed envelopesPlease mail your complete application, without binding or staples, by March 1 st 2010 to :Summer Research ProgramAlice Emery-GoodmanSV/DOStation 19CH-1015 LausanneEPFL Application for Summer Research Program 2010

EPFL Summer Research Program 2010: Letter of recommendationApplicant,Name of ApplicantDateSignatureDear Referee,The person named above is applying for admission to the EPFL Summer Research program 2010 in LifeScience and Technology. We would appreciate your personal evaluation of this applicant.On the following scale, please rank the applicant against other students in comparable fields and indicate thecomparison group used (e.g.: final year undergraduate EE students at your university). If you can rank thecandidate precisely in her / his class, please do so.Comparison group :Rank :………/………Bottom quarter Third quarter Second quarter Top 25% Top 10% Top 5% Top 1-2%Please give your comments on reverse side or attach your letter to this form.Referee's namePosition/titleInstitution/companyAddressDateSignatureThis form is to be handed back to the applicant in a closed envelope sealed with your signature, intime for her / him to meet the above mentioned deadlines.EPFL Application for Summer Research Program 2010