Last Name: *       
First Name: *       
Middle Name:       
Title (Mr., Ms., Dr., etc.): *
Term for which You Wish to be Considered:*      
Proposed Program and Degree Objective:*      
Area of Specialization:*      



Current Address:      
Please provide the specific address where you can be contacted during this application process
Current Address Line 1:*      
Current Address Line 2:       
City: *       
State/Province:       
Zip Code:      
Country:*      
Telephone Number
(Include Area Code):*      
Fax Number:       
E-mail Address:*      
US Citizen: *       
Yes
No


GRADUATE RECORD EXAM (GRE)
If available, scores from this exam must have been taken within 5 years from your intended term of matriculation at UCR
GRE Test Date:        
      Month:      
      Year:      
Verbal  
      Score:      
      Percentile:      
Quantitative  
      Score:      
      Percentile:      
Analytical  
      Score:      
      Percentile:      
Subject  
      Score:      
      Percentile:      
TEST OF ENGLISH AS A FOREIGN LANGUAGE (TOEFL)
For applicants whose first language is not English.
If available, scores from this exam may be not older than 2 years from your intended term of matriculation at UCR.
EXAMPLE:       for Fall 2003, exams taken prior to September, 2001 will not be accepted.
TOEFL Test Date:        
      Month:      
      Year:      
Score:      
   
Please provide the entire school name, city and state or country.
Most recent school name and location:*      
Major course of study at this institution:*      
What degree has been or will be conferred at this school?:*      
Date of conferral:        
      Month:*      
      Year:*      
Estimated overall GPA at this school:*      
   
If you have corresponded with or been interviewed by a member of our faculty about your plans for graduate study, please indicate the date and individual concerned.
Faculty Name:       
Department:      
Date Contacted:       
   
Please provide a brief statement of your interests in the context of particular faculty members of our department and their research. A SHORT PARAGRAPH ABOUT YOUR INTERESTS CAN BE VERY HELPFUL FOR US IN MAKING SURE YOUR FULL APPLICATION, WHEN IT ARRIVES, IS ROUTED TO THE APPROPRIATE FACULTY. Don't take the time to formulate your full Statement of Purpose for inclusion here. *


* - indicates a required field.
Please verify that all required fields are completed and submit.