ECE Pre-Application Form

First Name (Given Name) *

Last Name (Family Name) *

Email address:

Citizenship *

Date of Birth (MM-DD-YYYY): *

Ethnicity (OPTIONAL, US Residents Only)

Degree Sought *

Enrollment Period *

Assistantship Sought *

Research Interests

Faculty Members of Interest 1

List up to five faculty members who are closest to your research area of interest. This helps us to match faculty members with prospective students. This does not limit whom you may later select as your advisor. Refer to our faculty webpage or research webpage to learn more about the faculty members and their research.

Faculty Members of Interest 2

Faculty Members of Interest 3

Faculty Members of Interest 4

Faculty Members of Interest 5

TOEFL Test Score and Date of Test

GRE Test Score and Date of Test

Background College/University Name

Degree(s) Obtained

Major Field of Study

Years Attended (MM-YYYY to MM-YYYY)

Degree Received/Expected Date (MM-DD-YYYY)

Reference 1

Please provide name, email address, position, and affiliation of three references to support your application.

Reference 2

Reference 3

Certify

Yes

I certify that the information provided on this application and any supporting documents is true and accurate to the best of my knowledge and understand that omissions or falsifications may result in withdrawal of a decision to accept me.

Department of Electrical and Computer Engineering

Undergraduate

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