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Submit Information to the Student
Publications and Fellowships Database
Directions
Print out this page, fill out all
applicable parts, and
mail it to:
Karen Zier, Ph.D., Director
Medical Student Research Office
Annenberg 5-04A
Box 1002
Name: _______________________________________
Year: ________________________________________
Phone: _______________________________________
email: ________________________________________
Fellowship Completed:
- Name:
___________________________________________
- Description:
_____________________________________________
_______________________________________________________
_______________________________________________________
Publication:
- Check one: Abstract___ Peer-Reviewed
Article___
- Authors:
___________________________________________
__________________________________________
- Title:
____________________________________________
_____________________________________________
- Journal:
_____________________________________________
- Issue/Date:
______________________________________________
- Pages:
______________________________________________
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