SUMR Program Application Form

Please fill in ALL the fields below. Incomplete applications will not be reviewed.

All applications must be received by February 15, 2008, and will be reviewed by a committee of Penn faculty and staff.

If you would like to receive a confirmation that your complete application has been received by us, please email Kelly Johnson (kellj@wharton.upenn.edu).

First Name

Middle Initial

Last Name

Local Address

City

State

Zip

Email

Gender Male Female

Ethnic Background

If you selected Other or Multi-Ethnic, please specify:

College

School (Penn students)

Major(s)

Cumulative GPA

Year of Graduation

SAT Scores* Verbal Math

*If you did not take the SAT, please explain why, and include alternate test scores (for example,
ACT scores):

College math courses taken:
I have not taken any math courses.

Course Number Course Name Grade

College health care related courses taken:
I have not taken any health care related courses.

Course Number Course Name Grade

Essay (400-500 words): What do you hope to get out of participating in the SUMR program? What areas of health services research or health care interest you?

Are there any specific LDI Senior Fellows and/or Wharton faculty you have worked with or would want to work with? Yes No

If yes, whom?

How did you hear about the SUMR program? (Please check all that apply.)

SUMR Brochure

Penn Faculty/Staff

Career Services

Student/Campus Organization Please specify which organization

LDI Web site

Friend

Other

Please note, for your application to be considered complete, the following must also be emailed (to Kelly Johnson at kellj@wharton.upenn.edu) by February 15, 2008:

A photo of yourself (.jpg, .gif or .tif) - In the subject field, please type "photo_your last name, your first name"
Two letters of recommendation - In the subject field, please type "recommendation_your last name, your first name"

Please contact Joanne Levy, Deputy Director of the Leonard Davis Institute of Health Economics, at levyj@wharton.upenn.edu or by phone at (215) 898-1655 if you have further questions about the SUMR program or the application process.