EmailMe Form - The University of Manitoba Department of Chemistry

1. PERSONAL INFORMATION

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

2. DEGREE SOUGHT

*

3. AREA OF INTEREST

Select a primary area of interest *

Select a secondary area of interest

4. ACADEMIC BACKGROUND

if you are still a student, please include your current program.

A. Undergraduate

Please describe all undergraduate degrees obtained or in progress.

Degree: *

Field / Subject: *

Year Awarded/Expected: *

Length of Program (3 or 4 Years): *

Institution: *

Country: *

Cumulative Average Grade: *

Average in Final Year: *

Grading system used: *

Your Standing in Class: *

B. Graduate

Please describe any graduate degrees obtained or in progress.

Degree:

Field/Subject:

Thesis Title

Year Awarded/Expected:

Institution:

Country:

Cumulative Average Grade:

Grading system used:

C. Relevant courses completed

Provide the course title and grade obtained for up to five courses relevant to your program of interest. Include both undergraduate and graduate courses, if appropriate.

Course Title & Grade:

Level:

Course Title & Grade:

Level:

Course Title & Grade:

Level:

Course Title & Grade:

Level:

Course Title & Grade:

Level:

5. TEST SCORES ON GRADUATE RECORD EXAM (GRE)

If your Undergraduate degree is not from a Canadian University, please indicate your score on the Graduate Record Examination (General Test and Chemistry Test) if available.
GRE scores are not mandatory but are very helpful in assessing applications.

GRE General Score: Verbal

Test Date:

DD / MM / YYYY

GRE General Score: Quantitative

GRE General Score: Analytical

GRE General Score: Chemistry

Test Date:

DD / MM / YYYY

6. ENGLISH LANGUAGE FACILITY

Primary Language: *

English

Other

if other language, please indicate:

If English is not your primary language, indicate your score on a standard test below:

TOEFL Score: *

Tested: *

Paper

Computer

Test Date:

DD / MM / YYYY

Other test (Name) & Score:

Test Date:

DD / MM / YYYY

7. ADDITIONAL INFROMATION

Provide any additional information which may help us to assess your suitability for our graduate program (e.g. publications, awards, professional experience since graduation):

8. SEND YOUR REQUEST

Thank you for your interest in Chemistry at The University of Manitoba.