Princeton University
Department of Chemical Engineering
Certificate Program in Engineering Biology
Enrollment Form
Students: You must fill out this form and file it in the Undergraduate Program Office (E-Quad
Room A201) in order to be enrolled in the certificate program and to enjoy whatever benefits
that might entail, including invitations to seminars and access to certain independent
research topics.
Date:
Name:
Mailing Address:
Major:
Class of: 20
Email Address:
Phone:
University ID:
-----------------------------------------------------------------------------------------------------------------------------------------------------------Please fill in your planned course schedule. If you do not know what you will be taking, leave
question marks. Make sure that you list enough courses to satisfy your departmental and
program requirements. Indicate departmental requirements with an asterisk (*).
Fall
Spring
Freshman Year
Sophomore Year
Junior Year
Senior Year
Engineering Biology Enrollment Form
02/05/16
Page 1 of 2
From the schedule on the previous page, list those courses that you propose to use to satisfy
the “Engineering” and “Biology” course work requirements (5 courses each):
Engineering
1.
2.
3.
4.
5.
Biology
Taken?
Y/ N
Y/ N
Y/ N
Y/ N
Y/ N
1.
2.
3.
4.
5.
Taken?
Y/ N
Y/ N
Y/ N
Y/ N
Y/ N
If you change the course listed above, it may be necessary to fill out a new form; consult the
program office for details.
Topic of independent work (if you have already made arrangements):____________________
_____________________________________________________________________________
-----------------------------------------------------------------------------------------------------------------------------------------------------------Department:
Advisor:
Please provide a short statement regarding your interests in “Engineering Biology” and the
logic underlying your coherent program of coursework (e.g. “I am a pre-med interested in
neurophysiology and behavior”, “I am interested in protein structure and plan to attend
graduate school in biophysics”, “I think biology is neat, but so are math and physics”, “I want
to make $$$$ as an engineer, but I want to learn molecular biology as well”, ….)
______________________________________
Signature of Director of the Engineering Biology program
After obtaining the signature above, return this form to Julie Sefa, E-Quad, room A201. We
suggest you keep a copy of this form for your own records. If there are significant changes in
your course schedule (especially in the 10 courses listed above), or if you decide to
discontinue your participation in the program, please let us know.
Engineering Biology Enrollment Form
02/05/16
Page 2 of 2