Native Explorers STEMM Summer Internship

Thank you for your interest in the Native Explorers STEMM Summer Internship. The application and letter of support from an instructor/professor are due by February 1st at 5:00 pm (CST). The email address and/or phone number you provide on this application form will be used to notify you of your acceptance or rejection to this summer program. Feel free to visit the Office of American Indians in Medicine and Science at OSUCHS at https://medicine.okstate.edu/oaims/ or contact us for additional information.

First Name

Middle Name

Last Name

Current Address

Country

Street

City

Region

Postal Code

Permanent Address

Country

Street

City

Region

Postal Code

State of Residence

Mobile Number

Email Address (primary, not school)

Date of Birth

Place of Birth

Country

City

Region

Gender or Sex

Female

Male

Care not to answer

Tribal Status

Member of a U.S. Federally Recognized Tribe

Yes

What is your tribal affiliation?

CDIB Number

Education Information

University Attending

College Credit Hours Completed

Classification

Senior

Junior

Sophomore

Freshman

Do You Have a Declared Major? If So, What Is It And Why Did You Choose Your Major?

Which fields in Science or healthcare career interest you?

Science

Anatomy

Biology

Biomedical Sciences

Paleontology

Healthcare

Physician

Physician Assistant/Associate

Behavioral Health

Nursing

Dentistry

Physical Therapy

Other

Other:

Family Information

Mother / Guardian Name

Relationship (If NOT Mother)

Address

Country

City

Region

Postal Code

Highest Education Level (High School, GED, Bachelors, etc)

Highest Education School Name

Living

Yes

In Same Household

Yes

Occupation

Father / Guardian Name

Relationship (If NOT Father)

Address

Country

City

Region

Postal Code

Highest Education Level (High School, GED, Bachelors, etc)

Highest Education School Name

Living

Yes

In Same Household

Yes

Occupation

Interest

How Did You Hear About Native Explorers STEMM Summer Internship?

News Paper

Friend (Name of person)

Tribe (Name of person)

Professor (Name of person and department)

Other

Name of person that referred

Why Are You Interested in the Native Explorers STEMM Summer Internship?

Which careers in healthcare interest you?

Physician

Physician Assistant/Associate

Behavioral Health

Nursing

Dentistry

Physical Therapy

Other

Cultural Experiences

Language

Pow Wow

Artwork

Societies (Tribal affiliated)

Other

Why Should You Be Chosen To Participate Native Explorers STEMM Summer Internship?

Letter of Reference from professor must be submitted
If you are having your reference letter submitted at a later time, please email directly to kent.smith@okstate.edu.