Last name First name Middle

Address

Phone (if U.S): E-mail address:

Department applying to:

Master’s: yes no

Ph.D.: yes no

Area of special interest:

Research / Teaching experience, awards / honors:


Semester applying for: Fall Spring Summer Year

List all schools attended since high school and indicate dates attended, degrees earned, and grade point average (GPA):

1.

2.

3.

Have you taken the GRE ?

If so, Date Quant Analyt Verbal

Have you taken the MAT ?

If so, Date Raw Score

Are you a citizen or Permanent Resident of the U.S. ? yes no

If no, specify country of citizenship

International Students:
Have you taken the TOEFL exam ?

If so, when (most recent test) ? Most recent score

(If you are overseas, you must have a minimum 550 TOEFL taken within 24 months of your intended enrollment date)

Is your attending this university contingent upon receiving financial aid from SIUC ?
yes no

Prefer funding if at all possible, but could provide my own support. :
yes no

Please contact filip@siu.edu if you have questions about this pre-application or about the programs and degrees which we offer. Thank you for your interest in Southern Illinois University at Carbondale and the Center for Advanced Friction Studies.