Application for the Summer Workshop on the Dynamic Brain To apply, fill out the form below, upload the requested documents and click “Submit Application”. Please note – You will receive a confirmation email shortly after submitting. If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required. First Name * Last Name * Address 1 * Address 2 City * State 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 Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip/Postal Code Country Phone * Alternate Phone Email Address * Educational Institution * Current Level of Education Undergraduate Graduate Post Graduate Area of Study * Gender (Optional) Male Female Ethnicity (Optional) Hispanic/Latino Black or African American Asian American Indian/Alaska Native Native Hawaiian or Pacific Islander White/Caucasian Two or more races Reference 1 - Name * Reference 1 - Title and Position * Reference 1 - Email Address * Reference 2 - Name * Reference 2 - Title and Position * Reference 2 - Email Address * If you are a human and are seeing this field, please leave it blank. CV * Please upload your CV. Letter of Interest * Please upload a letter of interest (1 page maximum) detailing why you wish to participate in the workshop. Include a description of your current research and your wet lab and/or computational experience. Letters of Reference You must provide TWO letters of reference. If preferred, letters may be emailed directly to firstname.lastname@example.org or you may upload them via this form.