BIOMEDICAL ENGINEERING INTERDEPARTMENTAL PROGRAM

UNIVERSITY OF CALIFORNIA, LOS ANGELES

DEPARTMENT APPLICATION FOR GRADUATE ADMISSION

2010-2011 Academic Year - DEADLINE: December 15, 2009

IMPORTANT - PLEASE READ: This form must be completed and submitted to the Biomedical Engineering IDP Office by the deadline – no exceptions! Your file will not be processed until this form has been received. Please send to the attention of Larry Nadeau, either by fax at (310) 794-5956 or via email at , or via snail mail (mailing address on BME website, click on ‘Admissions’), but it must be received no later than December 15, 2009.

Last Name (family): / First Name: / Middle:

Date of Birth: Month: / / Example: mm/dd/yy


DEGREE OBJECTIVE: (Check one) M.S. (Comprehensive Plan) M.S. (Thesis plan) PhD

PREFFERED FACULTY ADVISOR (MS/Thesis and PhD Applicants only):

see list at http://www.bme.ucla.edu/facultyresearch/faculty.html

FIELD AREA(S) OF SPECIALIZATION:

Biomedical Signal/Image Processing & Bioinformatics (BSIP) Biocybernetics (BCB)

Biomedical Instrumentation (BMI) Molecular & Cellular Bioengineering (MCB)

Biomechanics, Biomaterials and Tissue Engineering (BMMT) Medical Imaging Informatics (MII)

Neuroengineering (BNE)

GRADE POINT AVERAGE: (Very Important!! It is extremely important that each applicant completes the following section and as accurately as possible)

DOMESTIC GRADING SCALE -- DOMESTIC INSTITUTIONS:

Applicants who are studying or studied at domestic institutions need to calculate the GPA for the last two years of study (junior and senior years, or, the last 30 units [semester] or 45 units [quarter] if the senior year is not completed) AND in the major (overall):

(Please Note: The formula to calculate GPA is posted at the following URL: http://www.bme.ucla.edu/admissions/requirements.html

GPA - Only Junior and Senior years for the Bachelor degree (all courses):

Number of units used for calculating Junior/Senior GPA:

GPA - Only in courses in the major for the Bachelor degree (all 4 years):

GPA in all science, mathematics, and engineering courses for all four years of your undergraduate studies. Do not include grades from fields other than the ones listed here.

Number of units used for calculating GPA in major courses:

GPA - MS Degree (overall):

INTERNATIONAL GRADING SCALE -- INTERNATIONAL INSTITUTIONS:

Applicants who are studying or studied at international institutions where the grading system is other than the US grading system also must calculate the GPA based on the last two years of study AND in the major (overall) using their own grading system. Examples: an applicant would write in an average of 17 from an institution that has a grading system based on the 20 point scale, or PASS or PASS with HONORS or PASS with DISTINCTION for institutions using that grading system, etc.

GPA - Only last two years for the Bachelor degree (all courses):

GPA - Only in courses in the major for the Bachelor degree (all years):

GPA - MS Degree (overall):

Last Name (family): / First Name:

INSTITUTIONS ATTENDED: List in chronological order with most recent date first.

Name of College or University / Attendance
Begin Date End Date / Major / Degree Title / Date or Expected
Date of Conferral
1.
2.
3.

PLEASE RESPOND TO THE QUESTIONS BELOW ONLY IF YOU ARE APPLYING FOR THE PHD PROGRAM:

How many of the following do you have?: (If your response is NONE, write 0)

·  Months of combined research experience:

·  Peer-reviewed publications:

·  Conference proceedings:

·  Papers accepted for publication or in press:

·  Published abstracts of presentations:

·  Oral presentations at scientific meetings or seminars:

·  Poster presentations at scientific meetings:

·  Research awards:

Additional comments regarding your research experience, publications, abstracts, poster and/or presentations, & research awards:

OTHER UNIVERSITIES: Please list the names of up to three other universities to which you are applying:

1.

2.

3.

Date:

*The Federal Privacy Act of 1974 requires that you be notified that disclosure of your Social Security number is mandatory pursuant to the authority of The Regents of the University of California under Art. IX, Sec. 9 of the California Constitution. This record-keeping system was established prior to January 1, 1975. The Social Security number is used to verify your identity.