University of Arkansas at Little Rock
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Department of
Applied Science
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Graduate Programs
PhD emphasis – Applied Biosciences
PhD emphasis – Applied Chemistry
PhD emphasis – Applied Physics
PhD emphasis – Computational Science
About Us
Welcome
About the Department
History of the Department
Important Dates
Facilities
Faculty
Faculty
Adjunct Faculty
Joint Faculty
Graduate Assistantship Application
Directions: Fill this form out completely. All academic references will be checked prior to approval of your assistantship. THIS DOCUMENT IS NOT AN APPLICATION TO THE GRADUATE SCHOOL! Your assistantship WILL NOT BE APPROVED UNTIL the graduate school has PROCESSED and ACCEPTED your application to them. Do NOT press the SUBMIT BUTTON UNTIL YOU HAVE COMPLETED THE ENTIRE FORM! Press the SUBMIT button only once; sometimes there is a time "lag" over the internet before your submission is confirmed.
Section I - Personal Information
Please enter your Legal Name in the following Name fields.
Last Name
*
First Name
*
Middle Name
*
Street Address
*
Please enter your Current Home Address.
City
*
State or Province
*
Country
*
Please use a 3 letter code.
5 Digit Zip Code
*
Please enter your 5 digit Zip Code.
Telephone Number
*
Please enter your Telephone Number, include your country code if foreign.
Fax Number
Please enter your Fax Number, include your country code if foreign.
Primary E-Mail Address
*
Enter your "Primary" e-mail address
Secondary E-Mail Address
If you have a second e-mail address please enter it here.
Section II - Background Information
The items on this application concerning race, ethnic origin, gender, and physical disabilities will be used for affirmative action reporting purposes only.
Citizenship
I am a:
*
United States Citizen
Resident Alien (immigrant)
Non-Resident Alien (here on Visa)
Visa Type:
If you are a NON-RESIDENT Alien, please indicate your Visa type.
I am a legal resident of the state of Arkansas:
*
Yes
No
Racial-Ethnic Category
I am:
*
American Indian or Alaskan Native
Asian or Pacific Islander
Black, Non Hispanic
Caucasian, Non Hispanic
Hispanic
Gender
*
Male
Female
Physical Disabilities
I have physical disabilities which I require special accomodation:
*
Yes
No
If YES, please list the disability or disabilities:
Section III - Academic Information
Academic Plans
*
Applied Biosciences
Applied Chemistry
Applied Physics
Computational Science
Please select from the drop down list above the specific emphasis area in which you are seeking a Ph.D. in (We do not offer Master's Degrees).
I am seeking admission for the:
*
Fall Semester
Spring Semester
Honors & Experience
List any extracurricular activities and/or any academic honors you have received.
Work Experience
List your work experience in business, science, or teaching.
Academic Experience
List (in chronological order, MOST RECENT FIRST) all Colleges and Universities you have EVER attended.
College or University attended:
Dates Attended: (mm/yyyy - mm/yyyy)
Degree Conferred:
College or University Attended:
Dates Attended: (mm/yyyy - mm/yyyy)
Degree Conferred:
Section IV - Personal References
List 3 personal references below. Each reference MUST come from a faculty member from one or more of the universities you have attended. The telephone number given for each reference CANNOT BE A HOME TELEPHONE NUMBER. The telephone number must be the "main" telephone number for the contact professor's DEPARTMENT, and CANNOT BE A DIRECT LINE. Your application WILL BE DENIED if you include a home telephone number. Include the country code if foreign.
Reference #1 - Full Name:
Department Name:
Name of University:
Department Telephone Number:
Reference #2 - Full Name:
Department Name:
Name of University:
Department Telephone Number:
Reference #3 - Full Name:
Department Name:
Name of University:
Department Telephone Number: