Current Utah Student Application Form
University of Utah
IGERT Training Program
in Nanobiosensors, Nanomaterials, and Microfluidics
Part I. Personal Information
Full Legal Name:
Daytime Phone: Evening Phone:
E-mail Address: Date of Birth:
Female or Male: U.S. Citizen or Permanent Resident:
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:
C. RESEARCH EXPERIENCE
Research Topic Advisor Institution Time Period
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
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
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.