Summer Premed

2024 Student Application

*Please read eligibility requirements for all programs

Please indicate your preferred session(s):

Online Research Course

Tuition Discounts: If the applicant is accepted and the tuition is received by February 14th, a discount of $50 will be applied. Students whose parents are a University of California employee will get an additional 10% discount after all other discounts are taken into consideration.

Are either of your parents employee(s) of University of California?

Yes

Are you applying for a scholarship?
Please read the scholarship criteria, and submit this application as well as the scholarship application.

Yes

Please enter your total enrollment fee for all program you selected here
(ignore $ sign and no coma. If not accurate, you will be notified via Email)

Scholarship applicants can put 0 in the box. Scholarships are very competitive and are granted to underserved students. Please read the scholarship eligibility carefully before you apply for a scholarship. Since we accept non-scholarship applications on a rolling basis, if you apply for a scholarship and your application is rejected or waitlisted, you may lose your position as a non-scholarship applicant.

Personal Information

Last Name *

*required

First Name *

*required

Middle Initial

Date of Birth *
(MM/DD/YYYY)

Gender *

Male

Female

Non-Binary

Ethnicity/Race

Ethnicity Other

Please type in other ethnicity

Education

Name of High School *		*required
Address of High School *		*required
High School Phone (555) 555-5555		Invalid Phone Number
Current Grade Level *		*required
Unweighted GPA (out of 4)*		*required

Contact Information

Home Address *		*required
City *		*required
State *		*required
Country *		*required
Zip *		*required
Student Cell *(555) 555-5555		*required Invalid Phone Format
Student Email *		Invalid Email Address
Home Phone (555) 555-5555		Invalid Phone Number
Parent/Guardian #1 Name*		*required
Parent/Guardian #1 Cell * (555) 555-5555		*required Invalid Phone Format
Parent/Guardian #2 Name*		*required
Parent/Guardian #2 Cell* (555) 555-5555		*required Invalid Phone Format
Parent/Guardian e-mail*		*required Invalid Email Address
Major hobbies and/or extracurricular activities (max 150 characters)

*Please describe why you would like to join the Program
(minimum of 750 characters, maximum of 1200 characters or 150-200 words). We recommend that you type your essay in a word document and copy and paste to this space.

Once you submit this application form, you will get a confirmation summary of what you provided to your email. The confirmation summary needs to be signed by you and your parents and returned to us by email at highschoolresearch@hs.uci.edu or mail. No actions will be taken on your application unless we receive the signed copy of this confirmation, and your transcripts. If you are accepted to the program, we will require you and your parents to complete other registration materials.