ABSTRACT SUBMISSION
1. Name of author
Author and Affiliation
Name of submitting author
Submitting author's school/institution
Institution where the research was conducted
Co-Authors and Affiliations - Provide names and institutions for any collaborators on the research. Please make sure the co-authors are aware their names are being submitted.
2. Contact Information
Name
First
Middle
Last
Suffixes
(degree obtained)
BS
MS
MD
PhD
MD/PhD
Other (specify)
Mailing Address (Preferred address to receive postal mail)
Street
Apartment/Suite
City
State
Zip code
Phone
Cell Phone
E-Mail
Must be valid - You will receive a confirmation e-mail at this address.
3. Additional Registration Information
Date of Birth
MM/DD/YYYY
Gender
Female
Male
Ethnicity (Optional)
African American
American Indian/Alaska Native
Hispanic (specify)
Asian American/Pacific Islander (specify)
White Non-Hispanic
Other (specify)
4. Institution, Academic Level, Expected Year of Completion (of submitting author only)
Current School/Institution
School/Institution Address
Street
City
State
Zip code
Phone
Academic Background
Date of Entry
Degree(s) Expected
Expected Year of Graduation/Program Completion
Major/Field of Study
Academic Level (check only one)
Postdoctoral/Research Fellow (please specify)
MD
PhD
MD/PhD
Other
MD/PhD Candidate
PhD Candidate
MD Candidate
DMD/DDS Candidate
Master's Candidate
Post-baccalaureate
(Please specify below your graduation year and name of the school)
College Student
Community College Student
Other (specify)
5. Research Title & Category
Title: (for example, "The Effect of Hospital Type on Lymphoma Outcomes in Boston")
Category: Please select which category best describes the research. If none of the categories below are appropriate, please check "Other" and type a new category in the space provided.
Public Health, Epidemiology, or Biostatistics
Microbiology, Immunology, Genetics, or Molecular Biology
Cellular Biology, Neuroscience, Biochemistry, or Physiology
Bioinformatics, Physcis, Chemistry, Engineering
Clinical or Social Science
Other (specify)
6. Funding source(s)/Research sponsor(s) Provide names of any sponsors of the research being submitted for presentation.
Provide the funding source(s).
7. Abstract (not to exceed a total of 400 words) must demonstrate the scientific problem and must
clearly contain :
Hypothesis/statement of the problem/research question/background
Methods used in the investigation
Summary/results of the investigation
Conclusion of the investigation/interpretation of results
Need help writing your abstract?
Abstract must be typed into the following four separate sections.
Hypothesis/statement of the problem/research
question/background
Methods used in the
investigation
Summary/results
of the investigation
Conclusion of the
investigation/interpretation of results
The abstract cannot exceed 400 words.
8. Have you ever participated in the New England Science Symposium?
Please read and sign below
I understand that Harvard Medical School (HMS) and the Biomedical Science Careers Program (BSCP) will retain the information in my application for their records. This information, including identifying information, will be used for tracking students/fellows through their academic and professional careers and for future communications, such as the BSCP newsletter.
I give consent for photographs, audio, video, or electronic images to be used by HMS and BSCP for exhibition, public display, publication, news media story, video, audio, or other electronic media, such as the Internet, television, CD-ROM, or DVD.
Name
Signature (your initials)
Date
MM/DD/YYYY
Please complete below if applicant is less than 18 years of age
Parent/Caregiver's Name
Parent/Caregiver's Signature (initials)
Date
MM/DD/YYYY
The symposium is supported by the National Institutes of Health through the Cooperative Agreement between Harvard Medical School Minority Faculty Development Program and the Office of Minority Health, Department of Health and Human Services.
Cooperative Agreement No. MPCMPO51007
Contact
Harvard Medical School
Office for Diversity and Community Partnership
164 Longwood Avenue, 2nd Floor
Boston, MA 02115-5818
Lise D. Kaye
lise_kaye@hms.harvard.edu
Phone
617.432.0552
Fax 617.432.3834
If you have problems submitting the form,
please contact Ferhan Gomulu at 617.432.1849 or 617.432.0552