* indicates a required field .   You may need to scroll down to see the full form.
 

* First Name:
Middle Name:
* Last Name:
* Current Telephone Number:
* Email Address:
Ph. D. Degree Program:		Select a department or program...BioengineeringBiological SciencesBiomedical SciencesChemistry and BiochemistryNeurosciences Other:
* Entry term at UCSD:		(example: Fall 2008)
* Year of study at UCSD:		1st2nd3rd4-5th
* Current Ph. D. Program Year:
Planned Thesis Topic (if known):
This program requires a foculty member who is your proposed Co-Mentor.  Click here for a list of program faculty to choose one or more Co-Mentors.  For more information on co-mentorship, click here.
If you have a Faculty Research Advisor, please enter the name and department:
Is your Faculty Research Advisor listed in the Program Faculty of the Multi-Scale Biology Specialization?		Yes   No
If you do not yet have a Faculty Research Advisor, please enter the name and department of your current Faculty Academic Advisor, as well as the name(s) and department(s) of your intended Faculty Research Advisor(s):
* Are your intended Faculty Research Advisor(s) listed in the Program Faculty of the Multi-Scale Biology Specialization?		Yes   No
* Enter the name of one or more proposed Program Faculty Co-Mentors:
* Enter the Department and/or Graduate Program of proposed Co-Mentors:
* Have your proposed Co-Mentors agreed to co-advise you?		Yes   No
* How are you currently supported?
Please select the Interfaces Program lab courses you have taken, if any, and which quarter: Lab Title Quarter Taken Year Course Names 1 Supramolecular Structure Determination Fall  200920082007 BENG/CHEM/BIOM 283 2 Numerical Analysis for Multi-Scale Biology Spring  200920082007 BENG/CHEM 276 MATH/PHAR 276 3 Light and Electron Microscopy of Cells and Tissues Spring  200920082007 NEU/CHEM 260 4 Magnetic Resonance Imaging Fall  200920082007 BENG 208 (BENG/RAD 278) 5 Optical Imaging of Structure and Function in Excitable Systems Spring  200920082007 PHYS 245 BGGN 265 6 Tissue Engineering and Regenerative Medicine Winter  200920082007  BENG 208 (BENG 277, BIOM 287)
* Please list the Interfaces Program lab courses you plan to take:
* Please enter a paragraph about your research plans ( limit 500 words ):   Word count:
* How are your research interests relevant to the Multi-Scale Biology Theme of the Interdisciplinary Specialization? ( limit 250 words ):   Word count:
* How will your current and planned course of study in the Interfaces Laboratory Curriculum advance your proposed Interdisciplinary research aims? ( limit 250 words ): Word count:
* Please attach a 1-page CV or resume describing your education, awards, presentations, and publications (limit of 250KB; Word doc, RTF, text, or PDF only please) :
* Are you requesting consideration for support from the Interfaces Training Grant?		Yes   No
* Do you meet the eligibility requirement for support on the MIBIB T32 Training Grant (click here for eligibility information)		Yes   No     Unsure
* Are you aware of and do you agree to the academic teaching requirement of the Multi-Scale Biology Specialization?		Yes   No
* Is your advisor aware of and agreeable to the teaching requirement of the Multi-Scale Biology Specialization?		Yes   No    Unsure
Questions or comments:

 

Official Web site of the University of California, San Diego
University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093
(858) 534-2230
Copyright ©2008 Regents of the University of California. All rights reserved.
Terms and Conditions of Use