Applicant: To be considered for admission, this form must be submitted to:

Graduate Admissions Committee
Department of Chemistry & Biochemistry
University of Alaska Fairbanks
Fairbanks, AK 99775-6160



NAME ______________________________________________ DATE _________________________

DEGREE APPLYING FOR: _____ M.S. _____ Ph.D.

PROGRAM: _____ Chemistry _____ Biochemistry/Molecular Biology

_____ Environmental/Atmospheric


EDUCATION
Degree/Major School Graduation Credits GPA
Date
______________ ___________________________________ _________ _______ _________

______________ ___________________________________ _________ _______ _________

______________ ___________________________________ _________ _______ _________

______________ ___________________________________ _________ _______ _________


GRE SCORES DATE TAKEN _________________

Verbal ______/________% Quantitative ______/________% Analytical ______/________%

Subject/Advanced Test: Subject _________________________________ Score ______/________%


LETTERS OF RECOMMENDATION
Have been requested from (name, title, institution)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________


TOEFL SCORES (International Students) Section 1) ______ 2) ______ 3) ______ Total _______


ATTACH A COPY OF YOUR ONE PAGE STATEMENT OF GRADUATE
AND RESEARCH INTERESTS AND PROFESSIONAL GOALS.