Supplemental Graduate Program Application

Graduate

Confidentiality Statement

The information provided will be used for the departments review process, which includes, but is not limited to, use for evaluation purposes by our departmental faculty and staff. However, the information provided will not be released to unauthorized persons or organizations.

If you have any questions, please contact Carol Yasutomi, Student Affairs Officer.

Last name:	First name:	MI:
Street Address:
City:	State:	Zip/Postal Code:
Country:
Telephone:	E-mail:

Additional Information

Citizenship:

California Resident?
Yes No

Birthdate (Month/Day/Year):
(optional)

Gender (optional):
Male Female

Ethnicity (optional):

Educational History

Undergraduate institution last attended:
Major
Degree	Date attained/expected:

Graduate institution last attended:
Major
Degree	Date attained/expected:

Interests

What specific area(s) of research interests you?

If Space Physics, may we share your information with the Earth & Space Sciences Department?
Yes No

What faculty may you be interested in working with?

What is your degree objective?
M.S. Ph.D.

How did you learn about our graduate program?
Poster/Advertisement
Referral (from whom)
The Web
Other (specify)

Other schools applied to: