TJU Student Research Resources

Transcript Release Form: Medical Student Research Program

Note: This form is required of all students applying to the following Medical Student Summer Research Programs: Basic Cancer; Translational Cancer; Heart, Lung and Blood; General Medicine; and Computer. Print this form, complete it and send it to:

Aveniel de Lorenzo, MS
Science Outreach Coordinator
Office of Faculty Affairs
College Building, Room G4
1025 Walnut Street
Philadelphia, PA 19107

by February 1, 2009. 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 Aveniel de Lorenzo, MS, Science Outreach Coordinator, Office of Faculty Affairs. 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