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Application Form
Imaging Structure & Function in the Nervous System
7/22/2025 - 8/12/2025
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United States
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Algeria
American Samoa
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Angola
Anguilla
Antigua & Barbuda
Argentina
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Aruba
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Belarus
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Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia & Herzegovina
Botswana
Brazil
British Indian Ocean Ter
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Cayman Islands
Central African Republic
Chad
Channel Islands
Chile
China
Christmas Island
Cocos Island
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Ter
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guyana
Haiti
Hawaii
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malaysia
Malawi
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Nambia
Nauru
Nepal
Netherland Antilles
Netherlands (Holland, Europe)
Nevis
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau Island
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Republic of Montenegro
Republic of Serbia
Reunion
Romania
Russia
Rwanda
St Barthelemy
St Eustatius
St Helena
St Kitts-Nevis
St Lucia
St Maarten
St Pierre & Miquelon
St Vincent & Grenadines
Saipan
Samoa
Samoa American
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
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Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Tahiti
Taiwan
Tajikistan
Tanzania
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Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Is
Tuvalu
Uganda
Ukraine
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United Kingdom
Uruguay
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Vanuatu
Vatican City State
Venezuela
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Virgin Islands (Brit)
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Wake Island
Wallis & Futana Is
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Academic Information
Graduate School
Years Attended
-
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
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to
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1927
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1935
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1938
1939
1940
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2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
Degree
MS, MA, PhD...
*Undergraduate School
Years Attended
-
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
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1955
1956
1957
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1959
1960
1961
1962
1963
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1968
1969
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1972
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1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
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2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
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2020
2021
2022
2023
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2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
to
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1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
Degree
BA, BS …
Have you previously attended a CSHL course?
No
Yes
If so, what year(s)?
1983, 1990 …
Additional Information
Diet
Vegetarian
No
Yes
Gluten Free
No
Yes
Kosher
No
Yes
Other Special Conditions and Food Allergies
Attached Files (5MAttached Files (5Mb Maximum per file): Assume 2 letters are required with your application, unless the course web page states otherwise. Applicants can either 1. Upload reference letters 2.Use the blind references option 3. OR combination of 1 & 2. (*** Please ensure your files are not password protected, locked, or encrypted. ***)
Curriculum Vitae (PDF or DOC)
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*Statement (PDF or DOC)
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Reference Letter 1 (PDF or DOC)
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Reference Letter 2 (PDF or DOC)
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Financial Aid Request (PDF or DOC)
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Blind References (Optional)
Referee 1
First Name
Last Name
Affiliation
Email
Referee 2
First Name
Last Name
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