Application: MyOpIA Summer Research Program:
An international collaboration between Berkeley Optometry & University College of Southeast Norway (USN)

	Complete form and email as an attachment to:
	Professor Christine Wildsoet OD, PhD
	University of California - Berkeley
  	School of Optometry, Room 588 Minor Hall
	Berkeley, CA 94720-2020
	wildsoet@berkeley.edu 

Name:	     	

Address:	     	

Phone:	E-Mail:     	

Pre-Optometry Institution:	     	

Major:	     	Pre-Optom GPA:	Current GPA:     	

Previous research experience:	  Yes          No      	Topic(s):	     	

Faculty members from your current and previous institutions who are willing to act as referees; list 3 with e-mail address or alternative contact information
     	
     	
     	

Research fields of interests 
(if known):

	     	

Resume (maximum of 500 words): Include in your resume, your long-term career goals, any relevant research experience/skills, and why you are interested in this program.