CIC: Applying for a FreeApp Waiver

Committee on Institutional Cooperation
Applying for a FreeApp Waiver

Please complete the following application form if you are interested in applying for a FreeApp waiver.

* indicates a required field

*Personal Information*
*First Name:
Middle Initial:
*Last Name:
*Gender:	Male Female
*Date of Birth:	(Use format MM/DD/YYYY)
*Street Address:
Address (cont.):
*City:
*State/Province:
*Zip / Postal Code:
*Phone:	(Use format 123-456-7890)
Email:
*Citizenship:	U.S. Citizen Permanent Resident Non-Resident Alien, Visa Status:
*Please choose the appropriate ethnic group(s):	African (Black) American Asian American Mexican American (Chicano) Puerto Rican Other Latino (Specify) American Indian White (Non-Hispanic) Other (Specify)

*Academic Information*
*Have you participated on a CIC campus in the Summer Research Opportunities Program?	Yes No
Which campus?
Check any of the following you currently participate in:	MARC McNair Howard Hughes COR Program
*Undergraduate University:
*City:
*State:
*Major:
*Department:
*Undergraduate GPA (Cumulative):
*Grading Scale:	4.0 Other (Specify)
*Current Year in School:	Freshman Sophomore Junior Senior Graduate Student
*Expected Graduation Date:	(Use format MM/DD/YYYY)
Graduate University (if applicable):
City:
State:
Department:
Check the post-baccalaureate areas that interest you:	Master's M.F.A. Ph.D. M.D./Ph.D.
Professional Schools:	Business Law M.D.
*Please indicate where you are applying:	University of Chicago University of Illinois at Chicago University of Illinois at Urbana-Champaign Indiana University Indiana University/Purdue University Indpls University of Iowa University of Michigan Michigan State University University of Minnesota Northwestern University Ohio State University Pennsylvania State University Purdue University University of Wisconsin - Madison University of Wisconsin - Milwaukee
*For which department or program are you seeking admission?

CIC: Free App - Graduate Recruitment Fair 2001 contact

If you have any questions, please contact Rose Jones at the CIC office at 217-265-8005 or via email