IGERT Application Form

Current Utah Student Application Form

University of Utah

IGERT Training Program

in Nanobiosensors, Nanomaterials, and Microfluidics

 

 

Part I. Personal Information

 

Full Legal Name:        ­                                                                                                                       

 

Mailing Address:                                                                                                                              

                            

Permanent Address:                                                                                                                          

 

Daytime Phone:                                              Evening Phone:                                                         

 

E-mail Address:                                              Date of Birth:                                                             

 

Female or Male:        U.S. Citizen or Permanent Resident:                                                               

 

Ethnicity (optional):                                                                                                                           

 

                                                                                                                                                           

 

 

Part II. Education, Honors, and Experience

 

A. INSTITUTIONS ATTENDED

 

Institution                   Major               Dates               Degree Earned                        GPA

 

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                           

 

B. STANDARDIZED TEST SCORES

 

Please list recent standardized test scores and test dates:

 

GRE Verbal:                   Quantitative:             Analytical:                 Test Date:                             

 

TOEFL:                                                                                                                                             

 

Other (specify):                                                                                                                                  

 

 

 

Name:                                                            

 

C. RESEARCH EXPERIENCE

 

Research Topic                                                            Advisor           Institution       Time Period

 

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                           

 

 

D. HONORS

 

Please list honors, awards, publications, conference presentations, extracurricular activities, and accomplishments that relate to the Nanobiosensors IGERT program.

 

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                        

 

                                                                                                                                                           

 

 

E. OTHER EXPERIENCE

 

Please list other experiences such as teaching, volunteer work, or work experience that relates to the Nanobiosensors IGERT program.

 

Dates of Activity                    Nature/Description of Activity

 

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                           

 

                                                                                                                                                            

 

                                                                                                                                        __               


Name:                                                            

 

Part III. Recommendations

 

Have 3 letters of recommendation sent on your behalf using the form attached. The evaluators should know your academic and technical capabilities especially as they pertain to proposed IGERT studies in nanobiosensors.   List the three individuals who will be writing letters for you:

 

     Name, Title                                   Institution/Company                           E-mail address

 

1. ___________________________________________                                                                 

 

2. ___________________________________________                                                                 

 

3. ___________________________________________                                                                 

 

Part IV. Transcripts

 

Please attach to the application form transcripts for all undergraduate and graduate institutions that you have attended. Unofficial or electronic copies are acceptable.

 

Part V. Educational Goals and Personal Statement

 

A. DEPARTMENTAL AFFILIATION

 

In which Univ. of Utah Department are you currently matriculated? ______________________

 

B. RESEARCH INTERESTS

 

To provide integrative and multidisciplinary education, IGERT students will have two faculty co-advisors from different departments directing their research. Identify two IGERT faculty members who agree by signing below (1) to direct your proposed research project described in the next section and (2) to provide funding for your research beyond the 1-2 year (depending on available funding) IGERT award. One advisor must be from your home department and the second from a different department.

 

                                                                                                                                                           

Name                                                               Signature                                             Date

                                                                                                                                                           

Name                                                               Signature                                             Date

 

C. PROPOSED RESEARCH PROJECT

 

Attach a two-page (maximum) summary of the multidisciplinary research project that you propose in the area of nanobiosensors for your Ph.D. dissertation. Include a description of relevant experience that you have as preparation for this research and also describe your future professional goals as they relate to IGERT training and education.

 

 
Last Updated: 7/8/13