LEAP Application Form

   * required fields
Name:
(Last, First, MI)		 *

Address
Current
Permanent (if different)
Street: *
City: *
State: *     ZIP: *       ZIP:
Phone:
123-456-7890		 *
Email: *
Intended Program:*

Examinations
GRE General* Test Date: (MM/DD/YYYY) *
Verbal score:/% * Quant score:/% * Analytical score:/% *

Academic Training
Institution & Dates Attended Major/Minor Fields Degree Conferred GPA
* * * *

Letters of Recommendation may be obtained from:
Title/Name Institution E-mail
*
*
*

Responses to the following are optional
  Gender     Race
 
To receive full consideration for an IGERT Fellowship in the LEAP program, you must submit
  • this completed application
  • a 1 page essay indicating your research interests and interest in participating in the LEAP program and
  • 2 letters of recommendation

 

To: leap@uic.edu

Or:

IGERT-LEAP, Attn: Mary Wais
University of Illinois at Chicago
840 West Taylor, MC 067
Chicago, IL 60607

Application Deadline: Monday, February 15, 2010

Note: Submission of this application does not constitute formal application for admission to UIC. IGERT Fellows will be selected from qualified Ph.D. students who have been accepted into participating UIC doctoral programs. Prospective Fellows must also complete an application for admission through the Graduate College at: http://grad.uic.edu/cms