Awards, Scholarships and Grants
Foundation for Genetic Technology
EXCEL Award
Application
DUE DATE
: Monday, February 5, 2007Deadline: Must be Postmarked by February 5, 2007
Mail To:
Foundation for Genetic Technology
EXCEL Award
P.O. Box 625
Biloxi, MS 39533-0625
SECTION I
- Biographical InformationNAME : ______________________________________________________________________________
Last First Middle Initial
ADDRESS:_____________________________________________________________________
Street City State Country Zip Code
PHONE NUMBER:_____________________
E-mail Address________________________
SOCIALSECURITY#_________________________
DATE of BIRTH:___________________ AGT MEMBER #:______________________________
NAME of COLLEGE/UNIVERSITY/PROGRAM:______________________________________
EXPECTED DATE OF GRADUATION:___________________ DEGREE:___________________
NAME of PROGRAM DIRECTOR:__________________________ ________________________
PHONE #: (___)________________
CATEGORY: (See Application Instructions )
Certificate Program:____________ Undergraduate Program:_________ __
Canadian Program:_____________ Molecular Diagnostic Program:_______
SECTION II
Use an attached sheet to submit a one-page essay stating your reasons for wanting to attend the Annual AGT Meeting.
SECTION III-Certification Statement
I affirm that, to the best of my knowledge, the above statements are correct. I understand that I am responsible for the submission of all required documents within the deadlines. The Foundation for Genetic Technology reserves the right not to process applications found to be late or incomplete.
________________________________________________________
Student’s Signature Date
I affirm that the above named student is currently enrolled in the Education Program indicated above.
______________________________________________
Program Director Signature Date
Foundation For Genetic Technology
EXCEL Award
Application Instructions
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AWARD
:1. The Foundation for Genetic Technology EXCEL Award consists of a Student registration to the AGT Annual Meeting, plus registration for one full-day workshop, or two half-day workshops.
2. Selection of the award will be made by a Panel of Reviewers without affiliation to any of the eligible programs (see above).
3. The decisions of the Panel of Reviewers will be final and reasons for the decisions will not be disclosed.
Foundation For Genetic Technology
EXCEL Award
P.O. Box 625
Biloxi, MS 39533-0625
ELIGIBILITY
:1. The Award is open to certificate and undergraduate students only.
2. Nominees must be student members of the Association of Genetic Technologists.
3. Students may be enrolled in one of the following educational programs:
a. NAACLS Approved certificate program in cytogenetics (U.S.)
b. NAACLS Approved undergraduate program in cytogenetics (U.S.)
c. Canadian Society of Laboratory Technology Approved Cytogenetics program (Canadian).
d. A formal university/hospital or laboratory based program in molecular diagnostic technology that includes a minimum of one semester, or the equivalent, of formal didactic coursework and a minimum 6-month clinical experience. This does not include on-the-job training or other paid experiences.
4. The student will submit a one page essay explaining the reasons for wanting to attend the AGT Annual Meeting.
NOTIFICATION:
1. The award recipients and their Program Director will be notified by phone by the Chair of the Awards & Scholarships Committee.
2. Student recipients will receive their monetary awards by mail at the time of selection. Certificates will be presented to them at the Annual Business Meeting of the Association of Genetic Technologists.
3. Nominees not selected will be notified by mail.