TJU Student Research Resources

Transcript Release Form

Complete, print this form, and send it to:

Andrea Cherenack
Office of the Dean, JMC
College Building, Room G4
1025 Walnut Street
Philadelphia, PA 19107

by February 15, 2012. For legal reasons, this form may not be submitted electronically.

I, ___________________________________________________ (print your name), hereby authorize the Registrar’s Office of Jefferson Medical College to release academic information including my academic transcript to Andrea Cherenack, JMC Office of the Dean. This information will be used by the Selection Committee of the medical student summer research program(s) to which I am applying. This information will be kept in the strictest confidence by the Committee.

I understand that, if selected for the program, I will be asked to commit 10 weeks to the project on a full-time basis. I also understand that I will be required to attend program seminars and meetings and to complete a research abstract and program evaluation prior to the end of the program.

 

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Social Security Number

 

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Name (signature)

 

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Date

Why Do Research?

Intramural Research at TJU:
JCGS
JCHP
JMC
Undergraduates

Extramural Student Research Programs & Funding Sources

Identify & Contact Jefferson Researchers