Eastern Michigan University
                                         Department of Chemistry
                                 Application for Admission to the Graduate Program

1. This form is for Departmental use only, and each applicant must also submit a separate application to the EMU Graduate School. You need not supply transcrpits with this form, but be sure to send them to the Graduate School with your application.

2. If you are applying for financial aid in the form of a Graduate Teaching Assistantship, you must have three letters of recommendation sent to the Graduate Coordinator, Department of Chemistry. These letters may be from former professors and/or employers. In addition, complete the Graduate Assistantship form and send it to the Graduate School.

Name (Last, First)                                Date
Present Address (Street, City, State, Zip)


Present Telephone Number

Present Employer and Address


Permanent Address


Education:
     College        Major          Entered   Left      Degree Received
1
2
3
4

Indicate your native language if other than English:
Area(s) of interest in the field of Chemistry:
Ultimate Professional Goal (teaching, industry, Ph.D.):
Date you wish to begin study:                Full-time:____ Part-time:____
Are you applying for an assistantship?

On the reverse side of this page, give any further information that you consider pertinent to this application.

                                   Signature

Mail to: Graduate Coordinator, Department of Chemistry, Eastern Michigan University, Ypsilanti, MI 48197