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 Rigmor Baraas PhD
	University College of Southeast Norway
	rigmor.baraas@usn.no

Name:	     	

Address:	     	

Phone:	E-Mail:     	

Upper Secondary School (Videregående Skole):	     	

Major 
(VG fagretning):	     	VG GPA:
  	

Pre-Optometry Institution (If you have another bachelor degree):	     	

Major:	     	Pre-Optom GPA:
  	

Bachelor in Optometry student:	Year: 	1st semester GPA:  
	Expected GPA after 1st year:
     	
Master in 
Optometry student:	Year: 	Bachelor GPA: 
     	Topic of master project:	

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.