Mount Sinai - Department of Community and Preventive Medicine

Environmental and Occupational Health Summer Program

Application for Summer Training in Environmental Health Research at
Mount Sinai School of Medicine


Last Name	First Name
E-mail Address

Address
City	State
Zip

Phone Number	Best Time of day to call

Current Medical School	Year of Medical School
College attended
Year graduated	Major

Did you work after college for more then one summer before starting medical school? Yes No
If yes, what did you do?

Have you done any work in environmental or occupational health, epidemiology, public health or the like? Yes No
If yes, what did you do?

Have you ever done any research? Yes No

What dates would you be available for the summer traineeship? It should take 8-10 weeks. From To

Please enter a brief statement of your interest in participating in this summer research program.
All information above will be electronically distributed when you hit the submit button below. Applicants may be contacted by Dr. Moline by phone prior to acceptance into the program.