Select One:
          I would like to apply for a new membership. (application will be processed upon receipt of membership fee)
          
          Please list my program. (I do not want to apply for ANDP membership at this time. I understand that the fee for nonmembers is $265.00)

Part A - PROGRAM INFORMATION

Name of Member Program or Department:    
         

Type of Program:
          Graduate

Institution:
         

Program Web Address (URL):
         

PhD Degrees or Programs Available: (e.g., Neurobiology, Psychology, Neuroanatomy, Neuropharmacology)

a.
b.
c.

Areas of Research Emphases:  Select all that apply

Aging
Behavioral Neuroscience
Biophysics and Channel Function
Cellular and Molecular Neuroscience
Cognitive Neuroscience
Computational Neuroscience and Modeling
Developmental Neuroscience
Glial Biology and Myelination
Learning and Memory
Neural Injury, Repaie and Regeneration
Neurobiology of Disease
Neurochemistry
Neuroendocrinology
Neurogenetics
Neuroimaging
Neuropharmacology
Neurophysiology
Motor Systems
Sensory Systems
Substance Abuse
Synaptic Structure and Function
Systems Neurobiology

Part B - CONTACT INFORMATION FOR ANDP BUSINESS (See Part C to list contact information for queries by students and other interested parties)

     PRIMARY CONTACT  (receives dues notice, ballots, and all ANDP announcements)  

Title:
          Department Chair
          Program Director
          Program Coordinator
          Other  

Name:
               Degree: 

Mailing Address:
         

City:        State:      Zip Code:       Country: 

E-mail Address:
         

Telephone Numbers:
          Phone:        FAX:   

 

     SECONDARY CONTACT  (receive informational mailings but not dues notices or ballots)

Title:
          Department Chair
          Program Director
          Program Coordinator
          Other  

Name:
               Degree: 

Mailing Address:
         

City:        State:      Zip Code:       Country: 

E-mail Address:
         

Telephone Numbers:
          Phone:        FAX:   

 

     ADDITIONAL CONTACT  (There is a $20 charge for each additional contact)

Title:
          Department Chair
          Program Director
          Program Coordinator
          Other  

Name:
               Degree: 

Mailing Address:
         

City:        State:      Zip Code:       Country: 

E-mail Address:
         

Telephone Numbers:
          Phone:        FAX:   

 

Information submitted below, in Parts  D and E, is published in the Directory of Neuroscience Training Programs on the ANDP website.

Part C - CONTACT INFORMATION FOR EXTERNAL QUERIES (Information is published in the Directory of Neuroscience Training Programs on the ANDP website) 

Title:
          Department Chair
          Program Director
          Program Coordinator
          Other  

Name:
               Degree: 

Mailing Address:
         

City:        State:      Zip Code:       Country: 

E-mail Address:
         

Telephone Numbers:
          Phone:        FAX:   

 

Part D - PROGRAM OR DEPARTMENT CHAIR/DIRECTOR

Title:
          Department Chair
          Program Director
          Program Coordinator
          Other  

Name:
               Degree: 

Mailing Address:
         

City:        State:      Zip Code:       Country: 

E-mail Address:
         

Telephone Numbers:
          Phone:        FAX:   

Part E - PROGRAM DESCRIPTION   (Information is published in the Directory of Neuroscience Training Programs on the ANDP website) 

Year Established:
         

Total Number of Faculty (Spring 2008):
         

Total Number Enrolled Full-Time Students (Spring 2008):
         

Demographics:

a. % US Citizens:  
b. % Female:  
c. % US Under-Represented Minorities:   

i. % Native Americans: Indian, Hawaiian, Alaskan or Pacific Islander:   
ii. % African American/Black (not of Hispanic origin):  
iii. % Hispanic or Latino Origin:  

Total Number of Graduates in the Last Five Years:
         

Number of Faculty Who Have Supervised Graduate Student Theses Projects in Their Labs in the Last Five Years:
         

Average Number of Years Taken by These Graduates to Complete the Program:
         

Admission Requirements:
         

How or Where to Apply for Admission:
          

Stipend/Assistantships and Financial Assistance:
              

Annual Tuition and Fees Costs:
         

   
Approximate Cost of Living per Year:
         

Housing Availability and Costs per Year:
         

University-affiliated Daycare Facilities Availability and Costs per Month:
          

How, if Necessary, to Apply for Stipends/Assistantships and Financial Assistance:
          

  Written Descriptor of Program - Limited to 300 Words.
            Please include all information about formal and informal training activities in Neuroscience.            
          

Part F - AUTHORIZATION

Date of Submission:  

Person Submitting Application:
          Name
          Title  

Part G - PAYMENT

Method of Payment:
          Check  Make check payable to Association of Neuroscience Departments and Programs; mail check to
                    Ms. Cynthia A. Burks
                    ANDP
                    41218 Roundup Road
                    Magnolia, TX  77354
          Credit Card  (Complete and submit credit card information below.  This information is submitted using a secure connection.)