UMBC: Graduate Horizons

Graduate Horizons--October 28 - 30, 2004

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APPLICATION FORM

GRADUATE HORIZONS APPLICATION FORM (Submit by September 14) General Information
Last Name:		First Name:	Middle Initial:
Current Mailing Address:	Apt. #:
City:
State:
Zip Code:
Preferred Telephone Number:
E-mail Address:
Gender:	Male Female

Ethnic Heritage (only for U.S. citizens and permanent residents): This information is requested for the purpose of determining compliance with federal civil rights laws. Your response is completely voluntary and will not affect consideration of your application. By providing this information, you will assist us in assuring that this program is administered in a non-discriminatory manner.
Native American or Alaskan Native African American Asian or Pacific Islander Hispanic Caucasian Other
Country of Citizenship:
If not a U.S. Citizen:
Are you a permanent resident of the U.S.? Yes No (this program is open to U.S. citizens and permanent residents only) Alien Registration Number:
Academic History Record
College/University Attended or Attending:
Major/Area of Study
Degree Received:
Date Awarded/Expected:
Overall GPA:
Major GPA:
Are you currently a graduate student?	Yes No
Intended Area of Graduate Study
Which UMBC degree program are you interested in visiting during Graduate Horizons?
What is your advanced degree objective? Please select one:
Research Projects: In one paragraph, describe your previous research or independent projects during the summer or academic year:

Additional Information
Please include any additional information that you would like to share with the Graduate Horizons review committee.

What other graduate visitation programs have you participated in?

In addition to this online application, you must send an un-official transcript to: Angela Walton-Raji UMBC Graduate School Administration Building, 2nd Floor 1000 Hilltop Circle Baltimore, MD 21250 Fax 410-455-5932 Name appearing on transcript (if different from your name above):