contact us

contact form

name:

email address:

postal (mailing) address:

phone:

sex: male female date of birth (m/d/y):

are you a permanent resident of the US or a US citizen? yes no

if not a US citizen, what is your country of citizenship?

current undergraduate or graduate University:

current status:
freshman sophomore junior senior grad student graduated

overall GPA: major GPA:

expected graduation date:

undergraduate major:

ethnicity (check all that apply):

Chinese/Chinese American	African American/Black	Filipino/Filipino American
Japanese/Japanese American	East Indian/Pakistani	Other
Korean/Korean American	White/Caucasian	decline to state
Thai, Thai American	Pacific Islander	Mexican/Mexican American
Vietnamese/Vietnamese American		Puerto Rican
Other Asian (specify)	American Indian/Alaska native (specify tribe)	Other Spanish American

are you a member of any of the following programs? (please check all that apply)
McNair
IRT
Mellon Mayes
I am not a member of any of these programs

describe your research interests:

Would you like to receive additional program information from other NSF SBES institutions? Yes No

May we share information about you with other NSF SBES institutions? Yes No

If you have questions about this form, please contact Gloria Chun at socscigrad@berkeley.edu or call 510.642.5565