GRADUATE LEVEL FELLOWSHIP APPLICATION

Directions for Completing Application:

  • Complete the form below using the "tab" key to move between fields.
  • Keep a copy of the text of your Mentoring Plan and provide a copy of the Plan to your Mentor.
  • If you would like a copy of your application, print the application prior to submission. For some text fields, such as project description, layperson's description, etc., the printed copy will only show a portion of the text. You should keep a separate copy of these items for your reference.
  • If you have any questions, contact the Keck Center at 713-348-4752 or keckcenter@rice.edu
NOTE: Prior to submission of this application, you must talk with your institution's Keck Center Program Institutional Representative. Applications submitted without Institutional Representative approval may not be considered.

Information in red is required.
APPLICATION FORM
Name of Institutional Representative contacted:
Level   PreDoctoral PostDoctoral

Applicants may be referred to other Keck Center training programs if it appears the applicant's interests are aligned with the aims of the other programs. Check here if you do not want your application referred to other Keck Center programs:

No, do not refer my application to other Keck Center programs.

Applicant
First Name Last Name Middle
Gender Ethnicity (optional)
Email URL
Birthplace
City, State, Country		 Birthdate (mm/dd/yyyy)
Permanent Address
Address 1
Address 2
City State   Zip
Country Phone
Current Address
Valid Until  (mm/dd/yyyy)
Address 1
Address 2
City
State  Zip
Country
  Phone Work Phone
Fax
U.S. Citizen  Yes  No   If no, please complete: Citizenship Status, Visa Type, and Visa Number
   Citizenship Status
   Visa Type
   Visa Number
Education
Current Institution
GCC Member Institution
Other Institution
 
Department
Current Mentor / Advisor
Current Mentor / Advisor Department

Have you taken a Biomedical Ethics course? Yes No
Please provide information about the Biomedical Ethics course taken.  Please include plans for this course as part of your mentoring plan.  
 

For Predoctoral Applicants:
Anticipated Ph.D.Degree Subject Area
Anticipated Degree Month/Year  (mm/yyyy, required if you entered a Ph.D. Degree Subject Area)

For Postdoctoral Applicants:
Thesis Title
Thesis Advisor
Thesis Advisor Department
Publications and Abstracts

All Applicants
  Other Institution(s) Attended and Location (City, State, Country if other than U.S.) Degree and Field of Study Degree Date
(mm/yyyy)		 Grade Point Average
1st For date and GPA enter 0's for non-applicable.
2nd
3rd

Testing Information
GRE General      
  Raw Percentile   Raw Percentile   Raw Percentile
Verbal Quantitative Writing
GRE Subjects
Subject Name Raw Percentile
TOEFL

Grant Support

Please list any previous grant support (federal or otherwise) and dates of the support.

  
 

Keck Center Fellowship Information
Primary Mentor and Institution
Co-Mentor and Institution
Desired Start Date Fellowship Type
What is your Primary Research Area? Other
What is your Secondary Research Area?
 
Provide 6-8 keywords describing your research area:
1: 2: 3: 4:
5: 6: 7: 8:
 
Project Title  

Project Description  max. 1000 words

  

used words (max. 1000 words)		  
 

Layperson's Project Description   max. 250 words
Note: A layperson’s project description is a simple description that would be understandable by someone with only basic science background.
It is for general purpose use.

  

used words (max. 250 words)		  
 
Career Goals  max. 500 words
Describe your overall career goals and how they relate to the broad area of Computational and Structural Biology. Describe the education, training and other career development experiences you will need to achieve your career goals, and how the W.M. Keck Center Training Program will help you achieve them.
 

used words (max. 500 words)		  
 

Mentoring Plan   max. 400 words
Mentoring and Training Plan
Please provide a brief description of the plan you and your mentor have jointly developed to achieve your career goals. Include anticipated didactic course work, anticipated research training, enrichment activities and personal development (e.g. writing and speaking skills), professional meetings to be attended, etc. The plan should include an estimated timeline for completion of the graduate or postdoctoral training program and specific milestones to be achieved. This plan should match the plan submitted by your mentor in his/her mentor recommendation.

  

used words (max. 400 words)		  

  Clear Form Values
The Gulf Coast Consortia The W.M. Keck Center for Computational Biology The W.M. Keck Center for Computational Biology
The W.M. Keck Center for Computational Biology
Gulf Coast Consortia, Rice University, MS 141, 6100 Main Street, Houston, TX 77005, phone 713-348-4752
The W.M. Keck Center for Computational Biology
Baylor College of Medicine UTMB Internal Medicine Rice University University of Houston MD Anderson Cancer Center UT-Houston