First Name Middle Initial Last Name

Address City State Zip Code

Email Address Telephone Number

Academic Information

Name of School Major Current Year Expected Graduation Date

Please list all statistics and mathematics classes completed

Equal Opportunity Services Applicants are required to help us comply with federal and state equal employment record keeping, reporting, and other

obligations, by answering the following questions on: Gender, race/ethnicity, and veteran service.

Gender: Male Female Prefer not to Say

Race/Ethnicity: Hispanic or Latino White Asian Black or African American Native Hawaiian or Other Pacific Islander American Indian or Alaska Native I do not wish to disclose Other _______________________________

In compliance with reporting guidelines of the the U.S. Department of Labor, Veterans’ Employment and Training Services, MSK is collecting information about its employees. All information you provide will be used strictly for this federal report and your responses will be confidential. Are you a Veteran? Yes No

Name of person providing letter of good academic standing: _________________________

Name of person providing letter of recommendation: _______________________________

Checklist of required items for application: (Application due by January 5th, 2018)

From applicant, e-mailed to BstQSURE@mskcc.org: • Resume• Statement of Interest (500 word or less)

The statement should address the following: (i) your career interests or goals and how QSURE fits intothese plans; (ii) your personal qualities that you bring to a collaborative research team; and (iii) give anexample of a challenge you faced in school or college last year - how did you address it? if you did notaddress it, why not?

• Completed first page of application

From dean, college counselor or equivalent, e-mailed to BstQSURE@mskcc.org: • Letter of good academic standing

From professor or equivalent, e-mailed to BstQSURE@mskcc.org: • Letter of recommendation

All letters must be emailed by the letter writers and not by the applicant.