Clare Boothe Luce/Maine Space Grant Research Scholars
This form must be completed in consultation with your faculty Mentor.
Please complete this form electronically and email, along with a scanned copy of your Bearings transcript, to Prof. Jennifer Taback at email@example.com by February 21, 2012. Your faculty mentor should email a letter of recommendation directly to Prof. Taback.
I am a United States Citizen: Yes__________ No___________
I am considering applying to medical school: Yes_________ No_________
Please answer the following questions; your completed form should be no more than two pages. If you are planning to be off campus during part of the award period, please describe how you will continue your research project during that time.