NMSU-RISE MEDICINAL PLANTS OF THE SOUTHWEST
PROGRAM
Application Summer Workshop 2008
This form and
an up-to-date unofficial transcript of academic work must be completed and sent
to: Dr. Mary O'Connell, Medicinal Plants Program, New Mexico State University,
P.O. Box 30003 MSC3Q, Las Cruces, N.M. 88003. For more information (575)
646-5172 or moconnel@nmsu.edu
The deadline for
receipt of applications for Summer 2008 is April 18, 2008
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Last
Name
First Name
MI |
Social
Security No. |
Date
of Birth |
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Current
Mailing Address |
Current
Phone No. |
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Permanent
Mailing Address |
Permanent
Phone No. |
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Email: |
Gender: M F US
Citizen/permanent resident: Y / N |
Race/Ethnicity
(optional*) |
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Academic
Major: |
Academic
Minor: |
Academic
Rank Fall 2008: (Fr., Soph., Jr., Sr.) |
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Cumulative
GPA: |
Cumulative
Hours: |
Cumulative
Hours in Science: |
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Highest
degree toward which you are now working: |
Field
of current, main interest: |
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Institution: |
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How
did you learn about the MPSW Project: |
Are
you currently employed at
NMSU? Y / N |
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Please provide three
references on your academic activities
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Name: |
Phone
No. |
Address: |
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Name: |
Phone
No. |
Address: |
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Name: |
Phone
No. |
Address: |
* Race/ethnicity is used for reporting purposes to the
programÕs funding source, the National Institutes of Health
Complete Short Essay on Back of This Page
Please write one or two
paragraphs on one of the following topics:
á your previous employment history
á your experience related to medicinal plants
á your interest in ethnic minority issues or health
disparities in biomedical research.
Additional
application forms can be obtained from our website http://medplant.nmsu.edu/, RISE Program office in Foster Hall
(Biology bldg), or from the Medicinal Plants director Dr. O'Connell in Gerald
Thomas, Room 179.