Affiliate Scholar Application Form

Please provide the following information to apply for Affiliate Scholar. Applications will be processed on the first business day of each month.

Contact Information

First Name

Middle Name

Last Name

Date of Birth

Work/School Email

Personal Email

Mobile Number

Academic Information

Institution Association **If you are a high school or middle school student, please provide school name.

UC Davis

LLNL

High School or Middle School Student

Other…

High School Name

Position Title

Primary Department

Mentor Name

Applicants must have a mentor to be an affiliate. A mentor could be a science teacher they admire, a student club leader they work with, a guidance counselor, or a similar adult who is providing academic, career, or scientific guidance.

Mentor Name

Applicants must have a mentor to be an affiliate.

Mentor Email

Your Degrees Achieved

If you are currently in high school, middle school or your educational status is not listed below, please select "Other" and specify when you will receive your diploma.

Re-order	Degrees	Month	Year	Weight	Operations
	Degrees Degrees Enter other…	Month	Year	Item weight

more items

What type of degree are you pursuing now or intend to pursue next?

Research Area Interests

(Including relation to cancer)

Career Goal

Have you participated in UC Davis Comprehensive Cancer Center workshop, symposia, or other similar event yet?

Yes

If yes, which event/s or program/s?

Have you participated in community outreach or fundraising for cancer research yet?

Yes

Please share why you would like to be affiliated with UC Davis Comprehensive Cancer Center.

Are you currently enrolled in an institutional training grant (e.g, T32, R25) at UC Davis?

Yes

Please upload your CV or biosketch

Maximum 2 files.
100 MB limit.
Allowed types: pdf, doc, docx.

ORC ID

ORCID, which stands for Open Researcher and Contributor ID, is a digital identifier (an ORCID iD) that distinguishes you from other researchers. An ORCID can be connected to professional information including affiliations, grants, publications, and more. It helps ensure you get recognition for your contributions to science. If you don’t already have an ORCID, sign up here.

ORC ID Number

Internship in Cancer Research

An internship with the UC Davis Comprehensive Cancer Center provides valuable research experience combined with mentorship and professional development designed to advance your career in biomedical research. If you are interested, please select your area of interest. Internships are limited and competitive and vary in length. Most are unpaid.

Field

Do not fill out this field