MARC Program


Tracking of MARC Scholars

A Follow-up Survey

1. Name: 

2. Sex:     Male     Female

3. Contact Information

Email:
Web Page Address (if available):
Telephone #: (cell) (office)
  (residence) (lab)
  (parents) (other)
Current Mailing Address Current Parent(s) Address

4. SUMMER RESEARCH INTERNSHIPS WHILE AT GSU

University/Corporation Year Mentor's Name Department
(a)
(b)

5. EDUCATION BEYOND GSU

Degree Pursuing or Earned University Major Mentor's Name Date of attendance Date of Graduation
From To (Known) (Projected)
Ph.D.
 
M.S.
 
PharmD
 
M.D.
Post Baccal.
Other (specify)

6. Research Topic (Please send an abstract and curriculum vitae to himaya@gram.edu):

Ph.D.
MS.  

7. Current position:

Institution:    Location:

8. Date Form Completed: 

 

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