6-Week Program July-August, 2011 Application Submission

MCTP Master Fellows Bridge Internship Program
Application Form
6-Week Program
July-August, 2011
Application Submission Deadline: May 31, 2011
You must complete and submit this form along with the other required materials by May 31st.
Your complete application must include the following items:
Application form.
Resume or curriculum vitae (maximum 2 pages).
Personal statement, a 250-500 word essay describing your academic and research goals and how
participation in the MCTP Master Fellows Bridge program would help you achieve those goals.
Indicate whether you have any college-level leadership or teamwork experience.
One letter of recommendation, preferably from math, science or engineering faculty at your institution. The
letter should be written on university letterhead.
Official transcript.
Application Instructions
Step 1. Complete this form and rename the file (ex. SMITHjohn.doc, with your last name in capital letters and your
first name in lower case). If you can’t save the file please print it, scan it and return it to by e-mail to
lut@cnsi.ucla.edu. Also attach your resume or curriculum vitae (as a Microsoft Word or pdf file), and
your personal statement (as a Microsoft Word or pdf file) to the same e-mail. The subject of your e-mail
should be Bridge Program 2011 and your name.
Step 2. Send the e-mail.
Step 3. Tell your referee that her/his letter is due May 31, 2011 and it can be sent as e-mail attachment
(lut@cnsi.ucla.edu), by fax (310-267-4918) or by U.S. mail. The letters must be received by May 31, 2011.
If you are submitting any material by U.S. mail, please use the following address
MCTP Master Fellows Bridge Internship Program
California NanoSystems Institute
570 Westwood Plaza
Building 114, MC 722710
Los Angeles, CA 90095-7227
Questions about the Bridge Program should be directed to Laurie Ultan-Thomas
E-mail: lut@cnsi.ucla.edu
Fax: 310-267-4918
MCTP Master Fellows Bridge Internship Program Application Form
Personal Information
Applicant’s Name:
(last, first, middle initial)
Home Address:
Cell Phone:
E-mail address:
Race/Ethnic group (select one):
American Indian/Alaskan Native
Other Hispanic/Latino
Pacific Islander
(please indicate)
Other Asian (not including Middle Eastern)
East Indian/Pakistani
Decline to State
Birth Date:
Citizenship Status (US citizenship or permanent residence status required)
U.S. Citizen
Permanent Resident
UCLA Admissions Data:
I have been offered admission to graduate school at UCLA for Fall 2011
I have officially accepted the offer for Fall 2011
I will be admitted to the following department (please indicate)
Biomedical Engineering
Chemical and Biomolecular Engineering
Chemistry and Biochemistry
Electrical Engineering
Materials Science and Engineering
Mechanical and Aerospace Engineering
Physics and Astronomy
Please note that previous experience is not necessary to be accepted to the MCTP Master Fellows Bridge Program, but
your answers to the following two questions will help us in the design of our program.
Experience in research laboratories or related work experience (instrumentation, electronics, lab protocols and/or other
Experience in computer programming (type of computer, language or software), either through taking a class or personal
The MCTP website has links to the web pages of the participating faculty. Please select up to 3 faculty whose projects
http://mctp.cnsi.ucla.edu/pages/faculty are of particular interest. Rank your selections and we will try our best to give you
your first choice.
__ Andrea Kasko
Chemistry and Biochemistry (Inorganic)
__ Xiangfeng Duan
__ Richard B. Kaner
Chemistry and Biochemistry (Organic)
__ Miguel A. Garcia-Garibay
__ Robin L. Garrell
__ Kendall N. Houk
__ Heather D. Maynard
__ Yves Rubin
Chemistry and Biochemistry (Physical)
__ Benjamin J. Schwartz
__ Sarah H. Tolbert
__ Paul S. Weiss
Chemical and Biomolecular Engineering
__ Jane P.-C. Chang
__ Harold G. Monbouquette
__ Selim Senkan
__ Tatiana Segura
Electrical Engineering
__ Kang L. Wang
Materials Science and Engineering
__ Timothy Deming
__ Bruce Dunn
__ Yu Huang
__ Qibing Pei
__ Vidvuds Ozolins
__ Yang Yang
Mechanical and Aerospace Engineering
__ Yong Chen
__ Chih-Ming Ho
__ Chang-Jin Kim
Physics and Astronomy
__ Stuart Brown
__ George Grüner
__ Jianwei Miao
Name and contact information of faculty references. If you participated in research in an industry or government lab,
you may use your staff supervisor as a reference. Please note that it is your responsibility to ensure that your letter of
recommendation are received by May 31, 2011.