Application for the Screening Procedure
1. Last Name:
First Name:
2. Student ID:
E-mail:
3. Local Address:
GPA in Breadth Courses:
4. Number of Units Completed:
GPA Overall:
5. Faculty Advisor:
6. Faculty Advisor’s e-mail address:
7. Research Track:
8. Please include all the breadth courses you have taken or are taking this semester
(please make sure to include each course in its appropriate group):
Group #
Course Title
Seminar in CS Research
Seminar in CS Research
Course
Number
597
597
Instructor
Grade Semester/
Year
Group 1
Group 2
Group 3
Group 4
Group 5
9. Please include all the depth courses you have taken or are taking this semester:
Course Title
Course
Number
Instructor
Grade Semester/
Year
1
2
3
10. Please include all the other courses you have taken at USC, including those you are
taking this semester (please add as many rows to this table as needed):
Course Title
Course
Number
Instructor
Grade Semester/
Year
1
2
11. Personal Statement
Please enter any information you think will assist the screening committee in determining your
research potential. For example list any papers accepted for publication, already published, or
being refereed. Indicate experience in research laboratories; interaction with USC faculty;
research interests, etc. (please attach additional sheet if needed).
12. (Optional) URL for additional information if any if you wish to provide any addition material
(e.g., copies of papers you published), please include one URL (where this material can be
found).