1999 SUMMER INSTITUTE IN STATISTICAL GENETICS
NORTH CAROLINA STATE UNIVERSITY
APPLICATION
__ Mr __ Ms __ Dr
Name _______________________________ ______________________
first middle initial last social security number
Occupation _________________________ Title _________________
Address ___________________________________ Phone ________
___________________________________ Fax ________
___________________________________ Email ________
___________________________________
EDUCATIONAL BACKGROUND (University/College level only)
Institution Major field of study Degree Year
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
BACKGROUND IN MATHEMATICS AND STATISTICS
List university/college-level courses:
Undergraduate Graduate
________________________ ____________________________
________________________ ____________________________
________________________ ____________________________
BACKGROUND IN GENETICS
List university/college-level courses:
Undergraduate Graduate
________________________ ____________________________
________________________ ____________________________
________________________ ____________________________
Previous participation in the Summer Institute in Statistical Genetics?
No____ Yes ____ Year ____
Scholarship (financial assistance) Requested? ___Yes ___No (see
Summer Institute webpage for scholarship information)
Signature _______________ Date _____________
Applications must be accompanied by a $25 application fee per person.
Fees must be paid by the beginning of each module. The total tuition
bill will be reduced by $50 for fees received by April 30, 1999.
Refunds will be given on fees (except the application fee) up to April
30, 1999. For further information concerning the Summer Institute,
please contact Ms Hibbard (919) 515-3574 or FAX (919) 515-7325, email
hibbard@stat.ncsu.edu, or visit the web page www.stat.ncsu.edu
Please complete and mail with check to: Debra Hibbard, Summer
Institute in Statistical Genetics, Department of Statistics, North
Carolina State University, Raleigh NC 27695-8203.
Please include:
Application Deposit ($25) __________
Tuition Fees ($300 per module) __________
Total __________
Less $50 if paid by April 30,1999 __________
Total enclosed __________
Balance due at start of modules __________
Make checks payable to NC State University or indicate your charge card:
___ Mastercard ___ VISA Card No. ________________________
Expiration date: _________ Signature: __________________________
Course Schedule (please check your selections)
---------------
__Module 1 May 26,27,28 Basic genetics
__Module 2 May 26,27,28 Basic statistics I
__Module 3 May 26,27,28 Forensic statistics
__Module 4 May 26,27,28 Basic statistics II
__Module 5 May 30,31,June 1 Population genetics
__Module 6 May 30,31,June 1 Quantitative genetics
__Module 7 June 2,3,4 Population genetics (repeats Module 5)
__Module 8 June 2,3,4 QTL mapping I
__Module 9 June 6,7,8 Disease gene mapping
__Module 10 June 6,7,8 QTL mapping I (repeats Module 8)
__Module 11 June 6,7,8 Molecular evolution
__Module 12 June 9,10,11 QTL mapping II
__Module 13 June 9,10,11 Bioinformatics
Dormitory Housing Application
-----------------------------
Please specify gender: __ Female __ Male
Date of arrival _____
Date of departure _____
___ Single room ($36 per night)
___ Double room, shared with _____________($18 per night each)