Application Form - Human Biology Distinguished Major Program
Please complete this form and submit it along with your personal statement, official UVA transcript,
and two letters of recommendation in a single packet.
Please Type or Print
FIRST NAME _________________ MIDDLE NAME ______________ LAST NAME____________________
UNIVERSITY E-MAIL _________________________________________
UNIVERSITY ADDRESS_____________________________________________________________________
TELEPHONE (permanent/cellular) ______________________________
EXPECTED YEAR OF GRADUATION: __________
CURRENT OVERALL GPA: __________ LAST SEMESTER GPA: __________
COLLEGE AREA REQUIREMENTS STILL TO BE COMPLETED (IF ANY):
LIST REQUIRED HUMAN BIOLOGY CORE COURSES COMPLETED or CURRENTLY ENROLLED IN (IF ANY):
HAVE YOU DECLARED OR ARE YOU PLANNING TO DECLARE A SECOND MAJOR (Yes or No):
If yes, indicate major here _________________
HAVE YOU DECLARED OR ARE YOU PLANNING TO DECLARE A MINOR (Yes or No):
If yes, indicate minor(s) here _________________
ARE YOU PLANNING ON STUDY ABROAD (Yes or No): _________ WHICH TERM________________
HAVE YOU BEEN INVOLVED IN INDEPENDENT RESEARCH (indicate in what capacity and if at UVA):
____________________________________________________________________________________________
FUTURE CAREER GOALS:___________________________________________________________________
POTENTIAL THESIS TOPIC (If you do not have one leave this blank):
SIGNATURE_______________________________________DATE_____________