TTR Application - Trails To Research | Montana State University

Online Application:

Please fill out the application with complete and accurate information. If you have any questions, please contact us.

Trails to Research
Montana State University
529 Leon Johnson Hall
Bozeman, MT 59717-1234

Instructor:
Christa Merzdorf
406-954-5456 (office landline)

[email protected]

denotes required fields.

Contact Information

First name

Last name

Email Address

Please provide an email account you check often

Alternative Email Address

Phone number (please include area code)

Alternative phone number Please provide an alternative reliable phone number

Address 1

Address 2

City

State

Zip /Postal Code

Country

Personal Information

Birthday

Please Check One:

Female

Male

Other

Tribal affiliation?

Yes

If yes, what is your tribal affiliation?

Current College

Major please fill in your major

Date of expected graduation from your current college

If you are at a two-year college: What four-year university do you plan on attending?

What is your intended major at the four-year university?

Do you have a physical disability that needs to be accommodated while you visit MSU? If yes, you will be contacted and the appropriate accommodations will be made.

YesNo

In addition to checking this box, please contact us as soon as possible so that we can make appropriate arrangements. Christa Merzdorf: [email protected] 406-994-5645 (office landline)

Housing at MSU

Housing: Housing will be in the MSU dorms from Sunday until Friday or Saturday (5 or 6 nights). It is not possible to provide family housing for one week. Thus, please expect to make your own arrangements for your children back home (or in Bozeman, should you have family or friends).

I am able to come on my own and will stay in the dorms.

Yes

I am able to provide my own housing (you will receive travel money and your meals will be covered).

Yes

When will you be departing?

I will depart on Friday after the course is over at around 4:30 pm

I will stay until Saturday morning (dorm checkout is by 11 am)

MSU Required Safety & Security Information

Have you ever been convicted of a felony (please include instances of deferred sentencing)?

Yes

Have you ever been subjected to court-ordered confinement for threatening or causing physical or emotional injury to persons or property?

Yes

Have you ever been disciplined, suspended from, or placed on probation at any educational institution for nonacademic reasons?

Yes

Have you ever been required to register as a sexual or violent offender?

Yes

NOTE: Answering “Yes” to any of these questions will not automatically prevent admission, but you will be asked by the university to provide additional information. This information will be reviewed by a campus committee to ensure campus safety. Any falsification or omission of data may result in a denial of admission or dismissal.

Applicants from outside Montana

If you are applying from out of state, please provide us with the contact information of an advisor, instructor, administrator or someone else from your college with whom we can make arrangements for your travel.

Name of college contact (first and last)

Position (advisor, instructor etc)

Email Address

Phone Number

College

Please us tell a little about yourself

Use the space below to share about yourself, please include your career interests and goals.

Course Prep

As part of this course, you will be studying the development of zebrafish embryos as a model for human health and also as an indicator of environmental health (an embryo is a developing organism after fertilization. A human embryo develops into a fetus.)

Substances in the environment affect the development of animals and humans alike. When a woman is pregnant, the substances she consumes and comes in contact with can affect human development. Since we cannot treat and observe human embryos, we will use zebrafish embryos instead and observe the effects of treatments of your choice on their development.

Thus, we ask you to provide us with ideas for treatments of the zebrafish embryos. In the space below, please list one or more ideas of any substances you would be interested in testing, whether they affect the development of fish embryos.

Treatment suggestions for zebrafish:

There is a NO cell phone policy for this course, when we are in the lab we will limit the use of cell phone to the afternoon of day 2 to act as a calculator. During the remainder of the course due to chemicals and liquids, cellphones must be put away in bags and pockets until the course finishes for the day.

I certify that I have read this policy and will abide by it.

Yes

Please remember to submit your transcript after completing and submitting this form.

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