Search Close Search
Page Menu

Forms - Summer Research Programs

Welcome to the University of Massachusetts
2021 Summer Undergraduate Research  Program

Congratulations on being selected to participate in the 2021 Summer Undergraduate Research here at the UMass Chan Medical School.

Please take a few minutes to complete each form. Forms with signatures cannot be emailed, only originals can be processed. Please submit all original documents together via postal mail.

If there are any questions, call the number listed below. It is imperative to complete ALL forms and return before April 12, 2021.

Please mail all original forms to:

Attn: Ms. Linhelle P. Charles
UMass Chan Medical School
55 Lake Avenue North, Rm. S3-104
Worcester, MA 01655-0002

Phone: 508-856-2444 

Participants will be paired by the lab Hosts based on participants' stated research interests and review of the full application. Once participants have been selected, the host will send an email with more information about the lab and reading assignments.

Travel Guidelines

Airline travel to attend the program will be paid for and scheduled by UMass Chan staff, as well as travel to/from Boston Logan, Worcester Regional or Providence T.F. Green airports. To make travel arrangements as soon as possible send me your travel form by email. If you have any questions call me at 508-856-2444  or contact me by email at Once tickets have been purchased, the participant will be responsible for the cost of any changes to their travel arrangements. Two pieces of luggage per flight (within the weight limits of the airline) will be reimbursed with a receipt. Travel reimbursements require receipts and will be paid after the program ends.

Canceled Tickets: Tickets are non-refundable. You will be liable for the cost of the ticket once the tickets have been issued.

All travel has to be booked before April 30, 2021. Participants that are driving please inform me by email at

If a participant chooses to make his/her own travel arrangements, the total travel allowance cannot exceed $500 per participant. Mileage and toll reimbursement are paid from point of origin and back for those who drive to Worcester one time only. Travel reimbursements require receipts and will be paid after the program ends.

Sunday, May 23, 2021 is the program arrival date with flights scheduled so participants arrive at WSU between noon and 4:00 pm. Program staff will be at the dorms between noon and 4:00 pm. Participants arriving after 3:00 pm should contact WSU Campus Police at (508) 929–8044 for dorm access.

Saturday, July 31, 2020 is the departure date. If an additional night's stay is required, WSU must be notified. Please let me know by July 19, 2021.


All students are required to stay at Worcester State University, Wasylean Hall, 486 Chandler Street, Worcester, MA 01602. Participants are responsible for preparing their own meals. WSU cafeteria is closed during the summer. All suites are furnished with kitchens that contain a refrigerator and stove.

Trainees will be randomly assigned to suite and roommates. Single rooms within a suite are available on a first-come, first-served basis. To guarantee a single room, submit a check payable to "UMass Chan Medical School" for $600 for a single person supplement with required program paperwork.  Otherwise, housing is free.


Participants that have any ADA needs for housing must fill out an ADA accommodation form.

Packages and mail

Program participants are responsible for shipping all personal items to and from Worcester. Packages received before May 23, 2021 will be taken to the dorms for check-in.
All packages should be addressed to the address as shown below:                                   
                                                                                                                                                                                         Participants Name                                                
                 C/o Linhelle Charles
                 University of Massachusetts Medical School 
                 55 Lake Avenue North, Room S3-104
                 Worcester, MA 01655-0002


All forms must be submitted at the same time.

 1. W-9-Form- (attach a copy of your Permanent Residents Card) W-9 example (fill out and sign) 

 2.  ADA Accommodations Form (only if needed)

 3.  NIH Stipend Voucher    Example for both vouchers

 4.  SURE Stipend Voucher

 5.  Health Information Form (fill out and sign) Send immunization records. A current PPD test (done within the last two months) is required with documentation sent prior to arrival May 24, 2020. All records must be reviewed by UMass Chan Employee Health Clinic for clearance to work in the labs.

 6. Positive TST Form (only if needed)

 7. Animal Medicine Health Information Form  (fill out and sign)

 8. Respirator Medical Evaluation Questionnaire (fill out and sign)

 9. Information Release Form (fill out and sign)

 10 Intern Letter

11.  Travel Information Form  -Airline Travel Information should be sent as soon as possible by email to (Do not include in packet of forms)

12. ALL Participants MUST provide a current copy of their health insurance card

The new 2020 CSURP Handbook will be available at a later date.

I look forward to meeting you on Sunday, May 23, 2021.


Ms. Charles

Program Administrative Coordinator

UMass Chan Medical School
55 Lake Avenue North, S3-104
Worcester, MA 01655-0002
508-856-2444 Phone