SUBMERGE Application - Part 1

Applicant Contact

First name: (**required!)    Middle name:
Last name: (**required! !)
UM Student Number (no dashes) (**required! ):
Street Address:   
City:    State: Zip :
Phone (include area code):
E-mail Address (**required!):

Academic Information

Major:      Academic Level:
Expected Graduation date:      Overall GPA:
Math/Science GPA:

References

Who will be writing your recommendation (a mathematics, biology, or natural resources faculty member):
Recommender name:   
Affiliation:   
Email:

Statistics

Please select the box that best applies to you. (This is for reporting purposes only)

African American/Black (not of Hispanic origin)
Hispanic/Latino (Spanish culture or origin, regardless of race)
Asian or Pacific Islander (includes the Indian sub-continent)
American Indian or Alaskan Native
White

Gender: Male Female      
US Citizen: Yes No
Perm Resident: Yes No   
Other Citizen:   
Birthdate: