Developing Undergraduate Researchers-Matter (DURA-M) Program Application - Center for Diversity and International Programs

Student Information

Name*

First Last

Local Address*

Street Address Address Line 2 City State ZIP Code

Local Daytime Phone

Local Evening Phone

Email*

Best way/time to reach me is

Permanent Address

Street Address Address Line 2 City State ZIP Code

Permanent Phone*

Name of relative who will know your address in the future

First Last

Address of relative who will know your address in the future

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

Gender*

Male
Female

Undergraduate Institution (name/location)*

Classification*

Major*

Minor*

Intended Field of Graduate Study*

Cumulative Undergraduate Grade Point Average*

Expected Date of Graduation (Semester/Year)*

Background Information

Ethnic Background (Check one)*

Are you Hispanic (or Latino)*

Yes
No
Intentionally Withheld

Are you Hispanic (or Latino)*

U.S. Citizen
U.S. Permanent Resident
Applying for U.S. Permanent Resident

Military Status

Are you currently under charge or have you ever been convicted of a felony or misdemeanor, other than minor traffic violations?*

Yes
No

If yes, you must submit a full written statement.

Current Financial Aid (Check all that apply)*

Grant
Loan
Work Study
Scholarship
None

Essay Questions

Please limit to 200 words or less. It is not possible to underline or italicize or to alter the formatting in any way.

Briefly explain why you are interested in Biomedical Research*

Describe your career/professional goals*

Certification*

By clicking this checkbox I certify that all of the information provided to UNT Health Science Center is true and correct to the best of my knowledge. (This is your electronic signature)