Application for USIBR Summer 2023

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

WEEK July 24- July 28, 2023
Address: 3201 Natural Sciences II
Contact us at (949) 824-3255
mdigman@uci.edu

https://sites.google.com/view/usibr2023/home

Email *

Applicant's Full Name:
*

Personal pronouns: *

Sher, Her, Hers

He/Him/His

They/Their/Theirs

Prefer not to select

Other:

Mailing Address:
*

Phone Number you can be reached at: *

Registered Student at: (please type the name of the College or High School you are attending): *

What year are you currently in?
*

Area of Interest (select one): *

Biology

Biomedical Engineering

Chemistry

Computational Sciences

Engineering/Other: Materials, Chemical

Mathematics

Physics

Pharmaceutical Sciences

Medical Sciences

Other:

Cumulative GPA (self-reported): *

If selected for the program, can you attend the entire week? (9-4pm) *

Yes

Maybe

Race (select all that apply) *

Of African descent (A person having origins in any of the Black racial groups of Africa, e.g. Africans, African Americans, AfroCaribbean, AfroLatinas/os)

Of Alaska Native or Native American descent with tribal affiliation (A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.)

Of European descent (A person having origins in any of the original peoples of Europe)

Of East Asian descent (A person having origins in China, Korea, Japan, Taiwan or Mongolia)

Of South Asian descent (A person having origins in Afghanistan, Pakistan, India, Bangladesh, Nepal, Bhutan, Sri Lanka or Maldives)

Of Southeast Asian descent (A person having origins in Thailand, Vietnam, Malaysia, Singapore, the Philippines, Laos, Indonesia, Brunei, Burma (Myanmar), Cambodia and Timor-Leste)

Of Mestizo descent (A person having Spanish and indigenous ancestry who neither identifies as white nor has tribal affiliation with the indigenous culture they are descended from)

Of Middle Eastern descent (A person having origins in any of the original peoples of the Middle East or North Africa.)

Of Native Hawaiian or Other Pacific Islander descent (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands)

Do not wish to provide

Other:

Required

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.