Pharmacology Graduate Program
REQUIRED FELLOWSHIP FORM

Name (First, Middle, Last or Family Name):

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Gender: Female Male

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Degree Sought: (check one)

PhD
MS
JD/PhD
JD/MS
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Undergraduate Degree:

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Other Degree or Graduate Degree (if applicable):

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GRE Scores: (if available, or date you will take the exam)

(Verbal - Quantitative - Analytical Writing)
GRE Percentiles:

(Verbal % - Quantitative % - Analytical %)

TOEFL Score: (if available, or date you will take the exam)

Areas of Interest: (check all that apply)

Behaviorial Pharmacology
Biochemical Pharmacology
Chemotherapy
Molecular Pharmacology
Pharmacogenetics
Other: (describe below)

List any honors, awards or scholastic distinctions you received in college:

Research Interests:

Other Comments:

List below 3 persons who are well acquainted with your academic and professional experience who you are asking to write letters on your behalf. Be certain to provide your recommenders with the full address of the Director of Graduate Studies in Pharmacology (see Application Instructions & Checklist):
(1)
Name, Position, Institution, Email address:
(2)
Name, Position, Institution, Email address:
(3)
Name, Position, Institution, Email address:

All the necessary information you need to complete your application is available at this website. However, if you are not able to complete the electronic application and would like a paper application sent to your current address, please check the box below:
Please send me a paper application packet.

Note: The Graduate School application for admission must be completed online (http://www.grad.umn.edu).

I certify that the information entered on this form is complete and accurate. I understand the following: 1) that misrepresentation of application information is sufficient grounds for denial of admission and for cancellation of admission or registration; 2) that submission of fraudulentnt credentials may also be a criminal offense; 3) that offical notification of admission or rejection is sent only the the Graduate School Office of Admissions.
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