National Research Institute of Tuberculosis & Lung Disease
Masih Daneshvari Hospital Internship Program
International student internship program at Masih Daneshvari Hospital/National Research Institute of Tuberculosis and Lung Disease (
NRITLD
) affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran
Application for Summer 2009 Internships
Name :
Last
First (Given)
Middle
Current Address :
Street Address
City
State
Zip code
Country
Permanent Address :
Street Address
City
State
Zip code
Country
Email Address :
Email Address
Phone :
Phone number
Mobile Phone
Gender :
Male
Female
Date of Birth :
Date of Birth (Example : 22/02/1980)
City of Birth :
City of Birth
Country of Birth :
Country of Birth
Country of Citizenship :
Country of Citizenship
University Attending :
University Attending
Enrollment Status :
Undergraduate
Graduate
Undergraduate (1st year – 4th year), Graduate
Colleges and/or Universities Attended (Dates of attendance, Major, GPA) :
Colleges and/or Universities Attended (Dates of attendance, Major, GPA)
Please list the places and periods of any visits abroad for purposes of research or education :
Please list the places and periods of any visits abroad for purposes of research or education
List course work applicable to your project’s focus of study :
List course work applicable to your project’s focus of study
Indicate foreign language ability, including level of proficiency
(Native speaker, professional, conversational, reading/writing only, elementary) :
Indicate foreign language ability, including level of proficiency (Native speaker, professional, conversational, reading/writing only, elementary)
Please list all honors and fellowships :
Please list all honors and fellowships
List work experience and extracurricular activities applicable to your project’s focus of study :
List work experience and extracurricular activities applicable to your project’s focus of study
How did you learn about this internship program ?
How did you learn about this internship program
Please submit the following materials according to the instructions:
1) Short essay: Please explain what you hope to obtain from participation in this internship and how it will contribute to your immediate and long-range goals. Within your response, please include answers to the following questions:
A.) How does the program fit into your academic career?
B.) What are your career goals and how does conducting research in your intended country of study contribute toward meeting these goals?
Please upload your file (Doc , Docx)
2) Project Proposal: Please explain the area of study you are interested in and the reason(s) behind it. Please also outline at least two other subject areas you would be interested in.
Please upload your file (Doc , Docx)
