12. Research interest(s):
13. Name any professors with whom you are specifically interested in working:
14. Names and address of three people who could be contacted for information about your academic qualifications:

1. Name:
   Telephone:
   E-mail:
   
2. Name:
   Telephone:
   E-mail:
   
3. Name:
   Telephone:
   E-mail:
   

15. Undergraduate major(s):

16. List in chronological order all colleges you have attended, including the University of Utah, regardless of length of attendance. Two official copies of transcripts from each school you have attended must be sent directly from the institution to the Department of Computer Science. Transcripts must be received before any action can be taken.

For International students: School records must be submitted in the original language with official English translations. Please list the diploma, certificate, or degree received in the original terminology rather than attempting to translate into American terminology. For example, if you received a Diploma, write Diploma, rather than bachelor's degree.

NOTE: Failure to list ALL institutions previously attended or degrees pursued may result in loss of credit and dismissal from the U of U. Also, if you were previously enrolled in a graduate program which was not completed, please provide a written statement explaining the reasons for noncompletion.

1. Name of institution:
   Location:
   Dates of Attendance, From (month/year) To (month/year):
   Degree Earned & Date Received/Expected:
   
2. Name of institution:
   Location:
   Dates of Attendance, From (month/year) To (month/year):
   Degree Earned & Date Received/Expected:
   
3. Name of institution:
   Location:
   Dates of Attendance, From (month/year) To (month/year):
   Degree Earned & Date Received/Expected:
   
4. Name of institution:
   Location:
   Dates of Attendance, From (month/year) To (month/year):
   Degree Earned & Date Received/Expected:
   

17. Indicate what you have been doing (e.g., employment, school, military) and where you have been for the past three years. Be specific and account for all months.

1. Dates of Activity, From (month/year) To (month/year):
   Employer or Activity:
   Location (city, state, country):
   
2. Dates of Activity, From (month/year) To (month/year):
   Employer or Activity:
   Location (city, state, country):
   
3. Dates of Activity, From (month/year) To (month/year):
   Employer or Activity:
   Location (city, state, country):
   
4. Dates of Activity, From (month/year) To (month/year):
   Employer or Activity:
   Location (city, state, country):
   

18. How did you learn about the department of computer science at the University of Utah?

19. What made you decide to apply to the department of computer science at the University of Utah?

20. Person to notify in case of emergency:
Name:
Relationship (optional):
Telephone:
Address:

The University of Utah is fully committed to policies of nondiscrimination and equal opportunity, and vigorously pursues affirmative action in all programs, activities, and employment with regard to race, color, national origin, sex, age, and status as a handicapped individual. Religion, sexual orientation, and status as a disabled veteran or veteran of the Vietnam era also are protected under nondiscrimination and equal opportunity empolyment policies. Evidence of practices not consistent with this policy should be reported to the Office of the President of the University, 801-581-8365. Any false or misleading information provided in the support of this application may result in dismissal from the Graduate School.

All the answers I have given in this application are complete and accurate to the best of my knowledge. Form must be completed and signed by applicant.
Please give e-mail address for verification: