Harvard Medical School Genetics Training Program

Application for Training Program
Please see Eligibility Requirements for Deadlines

Please use the TAB key to move from field to field
(pressing ENTER will submit the form)

* Training Program
(please check only one box which represents the specialty of primary interest. Interest in additional specialties can be noted in your personal statement. However, applications to other specialties are possible only after successful completion of 3 months in the primary specialty)
Residency
 Clinical Genetics Residency
 Medical Biochemical Genetics
Fellowship
 Clinical Biochemical Genetics
Clinical Molecular Genetics
Clinical Cytogenetics

* denotes a required field
* Desired Start Year
 (yyyy)
* First Name
Middle Name
* Last Name
* Present Mailing Address
Telephone (Primary)
Telephone (Cell/Alternate)
Telephone (Pager)
Permanent Home Address
(If different than mailing address)
* Email Address
* Birthdate (mm/dd/yyyy)
U.S. Permanent Resident
 Yes No
Place of Birth
Ethnicity
(Please check all that apply.)
African American Alaskan Native American Indian
Asian Hispanic Middle Eastern
Pacific Islander White Other
Ethnicity Detail
(If other, please explain.)
Gender
 Male Female
If non U.S. citizen, type of Visa held
(Only if you are not a U.S. Citizen)
If a non-citizen or non-permanent resident, do you have funding from your home country or other source? Explain.
(Failure to complete this section may delay your application review.)

Education
* Undergraduate University
* University Address
* Dates Attended
From-To (mm/yyyy - mm/yyyy)
Degree
* Medical School or Graduate School
Medical School or Graduate School Address
Dates Attended
From-To (mm/yyyy - mm/yyyy)
Degree
(i.e. Ph.D., M.D., etc.)
Residency or Fellowship Hospital/University
(for applicants with an MD)
Address
Dates Attended
From-To (mm/yyyy - mm/yyyy)
Specialty Field
Mentor/Program Director
Hospital/University (2)
(If applicable)
Address
Dates Attended
From-To (mm/yyyy - mm/yyyy)
Specialty Field
Mentor/Supervisor
If you are a graduate of foreign medical school, have you obtained certification from the Educational Commission for Foreign Medical Graduates?

* References

Please provide the names and contact information for the three references from whom you will be requesting letters of reference sent either via email to HMSgeneticstraining@partners.org or by mail: Mira Irons, Program Director, HMS Genetics Training Program, 77 Avenue Louis Pasteur, NRB 250, Boston, MA 02115.
Name
Institution
Telephone
May we
contact?

Foreign Medical Graduates, please email a copy of your exam results and ECFMC certificate to: HMSgeneticstraining@partners.org.

Please email your CV and Personal Statement to: HMSgeneticstraining@partners.org The personal statement should be a short 500 words or less description of why you are interested in the Clinical Genetics Training, what makes you a good candidate for the program and what your professional goals are.

"**Laboratory Applicants: please have your GRE scores and transcripts from college and graduate school sent to Amy McGlinn, 77 Avenue Louis Pasteur, Suite 250, Boston, MA 02115.

**Clinical Applicants: please have your STEP scores and medical school transcripts sent to Amy McGlinn, 77 Avenue Louis Pasteur, Suite 250, Boston, MA 02115."

THANK YOU FOR APPLYING.

If you have questions, please send an email to HMSgeneticstraining@partners.org, or call 617-525-4483.