First Name:   Middle Initial:

Last Name:

Mailing Address: Home Work

May we distribute your contact information to speakers and participants?
Yes No

Institutional Name:

Street Address Line 1:

Street Address Line 2:   *optional

City:

State / Province: ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING Not applicable   Postal Code:

Country:   (*please specify country if outside the U.S.)

Home Phone:      Work Phone:

Fax Number:

E-Mail Address:

Position:

Faculty
Post-Doctoral Trainee
Pre-Doctoral Trainee
Other

Applying to Attend:

RAND Mini-Medical School
RAND Workshop on Aging
Both

Funding:

RAND has funds to cover travel expenses for a limited number of attendees. Would you like to be considered? Yes No

Have you attended the RSI before? Yes No.     *If so, which year(s)?

Professional Information

References: List the names and E-mail addresses of two references.
1.
2.

Instructions for Providing Supplemental Materials:

The following supporting materials must be submitted:

• A curriculum vita submitted via E-mail in Word or PDF format.
• A statement of no more than 1 page describing your previous research experience, current projects, and plans for future research. This essay should also indicate the areas in which you would like further training (either substantive, methodological, or professional), and how you expect the RSI to benefit you professionally (must be submitted via E-mail in Word or PDF format).
• A letter of recommendation addressing the applicant's demonstrated abilities and commitment to future research in the field (may be submitted electronically).
• Please be sure to include your name clearly on all supplemental materials.

Please submit materials to:

Diana Malouf
RAND Summer Institute
malouf@rand.org

Note: You will receive an automatic email confirming the receipt of your application.