Student Researcher Database Interest Form

Name: First Last
Phone: - (###) - ### ####
Alternate Phone: - (###) - ### ####
Email:
What is your current standing? High school student Undergraduate: Freshman Undergraduate: Sophmore Undergraduate: Junior Undergraduate: Senior Other
If you are an undergraduate, what is your major?
What high school/college/university do you attend?
Which of the following types of research positions are you interested in? Paid Work study For college credit Volunteer (non-paid)
Which Penn State campus are you interested in working at? Penn State Milton S. Hershey Medical Center University Park, State College Either
Are you interested in working with a specific investigator? Yes No
Is yes, what is his/her name?
When would you like to start working?
When are you available to work? Some weekdays during the day Some weekdays during the evening Weekends
How many hours are you available to work per week? 1-3 hours 4-6 hours 7-9 hours 10-20 hours 20 or more hours
Please give a brief summary of your research interests and previous experience:
How did you hear about this website? Referred to it by another student Referred to it by an investigator/faculty member Came across it while surfing the PSIDO website