| |
|
|
 Indicates items that are required for submission. |
|
| Last
Name: |
|
|
| First Name: |
|
|
| Middle or Maiden Name: |
|
|
| Date of Birth: (Month, Day, Year) |
|
|
| Home Phone: (Area Code, Number) |
|
|
| Work Phone: (Area Code, Number) |
|
|
| Best Time to Call: |
|
|
| Mailing Address: (Number and Street, City, State, Zip) |
|
|
| Permanent Address: (Number and Street, City, State, Zip) |
|
|
| Email Address: |
|
|
|
| The following information is requested for
affirmative action purposes and federal reporting. Supplying it will
have no adverse effect on your admission.
Ethnic Origin: |
American Indian or Alaskan Native
|
|
Tribe: |
|
|
Location: |
|
|
Tribal Enrollment No: |
|
Asian
Black or African-American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Other
|
|
| Research Interests (Check one or more.) |
|
Biochemistry/Structural Biology |
|
Cancer/Cell Biology |
|
Gene Expression |
|
Genetics |
|
Microbiology/Immunobiology |
|
Neurobiology |
|
Other |
|
If Other, please list.
|
| GRE Aptitude Test |
|
Date Taken |
|
|
Verbal (score, percentile) |
|
|
Quantitative (score, percentile) |
|
|
Analytical Writing (score, percentile) |
|
| GRE Advanced Test |
|
Date Taken |
|
|
Subject |
|
|
Area (score, percentile) |
|
|
List in chronological order all colleges you have attended, including the
University of Utah, regardless of length of attendance. Include the
following information for each college attended:
Institution Name, Location, Dates (mo/year to mo/year),
GPA (0-4 scale), Degree & Date (awarded or expected) |
|
List the undergraduate science courses you have taken and the approximate
grade received in each:
Use A, B, C and list all grades received in a course. Where
appropriate, use the course listings below, but also list other, possibly
more specialized courses that you feel were relevant to preparing
for a research career.
| Example: |
Biochemistry, grade
Organic Chemistry, grade
Inorganic Chemistry, grade
Physical Chemistry, grade
General Chemistry, grade
Cell Biology, grade
Molecular Biology, grade
Calculus, grade
Quantitative Analysis, grade
Physics, grade |
|
|
Briefly describe any research projects in which you have participated:
Include project title, topic, research supervisor and dates.
(15 LINE LIMIT) |
|
List the names and institutional affiliations of at least three persons who
will be submitting letters of recommendation for you:
These should be people familiar with your academic performance
or your laboratory experience and research capabilities.
Example: Name, affiliation, telephone number |
|
| If you would like to upload your Personal Statement, you may do it now. The Personal Statement should be 1 to 2 pages in length, articulate and give evidence of a strong commitment to research. (Word, rich text, WordPerfect formats accepted.) |
|
|
| You may also upload your CV. (Word, rich text, WordPerfect formats accepted.) |
|
|
| Note: If you are not ready to submit your Personal Statement and/or CV now, you may email them to us at program.office@genetics.utah.edu before January 15, 2008. |
Please provide any other information you would like us
to consider in evaluating your application.
(15 LINE LIMIT) |
|
| We invite promising applicants to visit. Please list
the names of TEN faculty you would like to interview with during your
visit. |
|
The University of Utah is fully committed to a policy
of nondiscrimination and equal opportunity in all programs activities
and employment without regard to race, color, religion, national origin,
sex, age or status as a handicapped individual, disabled veteran or
veteran of the Vietnam era. Evidence of practices that are not consistent
with this policy should be reported to the Office of the President of
the University, (801) 581-8635.
|
|
| I
verify that all the answers I have given in this application are complete
and accurate to the best of my knowledge. If admitted, I agree to
observe all rules and regulations of the University of Utah and to
pay all fees and charges assessed. |
|
|
|
|
|
