College of the Liberal Arts

Last Name: First Name:

Mailing Address: City/State/Zip:

E-Mail:  Phone:

Undergraduate University:

Major: GPA(overall): Scale 4.0 : Other:

Year in College: Select Year Freshman Sophmore Junior Senior Expected Graduate Date:

Race/Ethnicity (Please check ALL that apply):

African American/Black Asian American Puerto Rican Other Latina/o White, non-Hispanic

Mexican American (Chicana/o) American Indian-Tribal Affiliation:

Other:

Are you in interested in summer research? Y N

Which Graduate Degree(s) Interest You?: Select Degree Master's M.F.A Ph.D.

What specific program/discipline interests you?: Select Program/Discipline Anthropology APPLIED LINGUISTICS COMMUNICATION ARTS and SCIENCES COMPARATIVE LITERATURE CRIME, LAW & JUSTICE ECONOMICS ENGLISH FRENCH GERMAN HISTORY INDUSTRIAL RELATIONS AND HUMAN RESOURCES PHILOSOPHY POLITICAL SCIENCE PSYCHOLOGY RUSSIAN & COMPARATIVE LITERATURE SOCIOLOGY SPANISH, ITALIAN, and PORTUGUESE WOMEN STUDIES TEACHING ENGLISH as a SECOND LANGUAGE

I understand that the information above will be submitted to the Multicultural Equity Programs Office in the College of the Liberal Arts Undergraduate