Graduate Program in Genetics

University of Alabama at Birmingham

Online Application

INSTRUCTIONS AND GENERAL INFORMATION:

(1) Please fill out the form accurately and completely
(2) Please do not forget to press the Submit button when finished.
(3) All admitted students receive a full fellowship.
(4) This application is free.
(5) How did you find out about us?

ACADEMIC YEAR FOR WHICH YOU ARE APPLYING



IDENTIFYING INFORMATION
BIRTH DATE (mm/dd/yyyy):
/ /
E-MAIL ADDRESS: PREVIOUS NAMES:
FIRST NAME: LAST NAME:
CURRENT ADDRESS:
 PERMANENT ADDRESS (If different from current):
CITY: CITY:
STATE: STATE:
ZIP CODE ZIP CODE:
COUNTRY: COUNTRY:
HOME PHONE: PERMANENT HOME PHONE:
WORK PHONE: COUNTY (Alabama Residents Only):
(Residence in Alabama is not a requirement for admission )
ETHNIC BACKGROUND: Federal law requires the University to report the ethnicity of all U.S. citizens and resident aliens in the following categories: please mark one.
Black, Non-Hispanic Hispanic Asian or Pacific Islander American Indian or Alaskan Native White, Non-Hispanic 		SEX:Male Female
ACADEMIC INFORMATION
DATE GRE TAKEN (OR EXPECTED TO BE TAKEN) (mm/dd/yyyy):
/ / 		GRE SCORES:
VERBAL:
QUANTITATIVE:
ANALYICAL:
GPA:
WILL YOU HAVE LIVED IN ALABAMA FOR 12 MONTHS BY THE DATE YOU WISH TO ENROLL?
HAVE YOU PREVIOUSLY APPLIED TO THIS UNIVERSITY?
If yes, under what status did you apply?
If accepted, did you register?
If you registered, under which semester could UAB locate your records? (For example: Fall 1999)
HAVE YOU EVER BEEN SUSPENDED, DISMISSED FROM, OR ENCOURAGED TO LEAVE ANY COLLEGE OR UNIVERSITY, OR ADVANCED PROGRAM?
IF YES, PLEASE EXPLAIN IN DETAIL:
ACADEMIC HISTORY
NAME OF INSTITUTION STATE DATES ATTENDED DEGREE MAJOR

RESEARCH AND WORK EXPERIENCE
NAME OF INSTITUTION STATE: DATES EXPERIENCE:
(Describe in a few words)

CITIZENSHIP AND RESIDENCY INFORMATION
NATION OF CITIZENSHIP:
COUNTRY OF BIRTH:
IF YOU ARE NOT A U.S. CITIZEN BUT YOU HAVE U.S. PERMANENT RESIDENCY, PLEASE GIVE YOUR ALIEN REGISTRATION CARD NUMBER:

TOEFL INFORMATION
If your native language is not English, you must provide us with your score in the Test of English as a Foreign Language (TOEFL) with TWE. Official TOEFL Score Reports must be sent by the Testing Service directly to UAB, Department of Genetics, at the address given at the end of the form.
DATE TOEFL WAS/WILL BE TAKEN(mm/dd/yyyy):

/ / 		SCORE:
VISA INFORMATION
(This section for non-U.S. Citizens Only)
If you are currently in the U.S., what type of visa do you hold Please choose your visa preference
If you are currently studying in the U.S., which institution are you attending?

CAREER GOALS STATEMENT
It is very important that you use the space below to provide a brief summary of your career goals and employment history.
Please feel encouraged to include any other information that you believe would improve your chances for admission.

SIGNATURE
I certify that the information provided on this application and supplemental documents is true and accurate to the best of my knowledge. I understand that omissions or falsifications may result in withdrawal of a decision to accept me. I further understand that I must request and provide official transcripts from all previous colleges or universities attended before I may be admitted to a degree program.
FULL LEGAL NAME:
TODAY'S DATE (mm/dd/yyyy):
/ /
The University of Alabama at Birmingham does not discriminate on the basis of sex, race, religion, color, national origin, Vietnam Era veteran status or handicapping condition in its admissions, employment and educational programs or activities. Inquiries may be referred to UAB Human Resources Management, 1717 11th Avenue South, Birmingham, Alabama 35294-4410.



FINAL INFORMATION
PLEASE READ BEFORE CLICKING THE SUBMIT BUTTON!
•Please check this form carefully to make sure that it is complete, and that all questions have been answered accurately.
•Please print a copy of the form for your records.
•Have official GRE results as well as TOEFL results forwarded to Institute code 1856 with Department code 0210.
•You must have THREE signed letters of recommendation, on official letterhead, written by people who know your academic abilities. These letters and an Evaluation Form for each one of them should be mailed to Dr. Ada Elgavish at the address below. Please click on the pink link above to access the Evaluation Form.
Ada Elgavish, Ph.D., Director
Genetics Graduate Program
Volker Hall 230
University of Alabama at Birmingham
Birmingham, AL 35294-0019

•Have your official college transcripts, official GRE results and official TOEFL results forwarded to the address above.
•When you are certain that the form is complete, please click the submit button below. Please click only once and wait for the confirmation message.

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