Dear Graduate Student,



Department of Biomedical Engineering

Undergraduate Student Information Sheet

Date:

First Name: Last Name:

Preferred Name: 10 Digit USC ID Number:

Circle One: BME BME Chemical BME Mechanical BME Electrical

BME Specialization: Biochemical Bioelectronics Biomechanics Neuroengineering Unsure

Circle One: Freshman Sophomore Junior Senior 5th Year+

Catalog Year: GPA:

Year of Entrance to USC: Expected Graduation:

Phone: ( ) ______ USC E-mail Address: ____

Hometown: ________________________________

Are you a double major? Y or N If yes, in what? Do you have a minor or plan to? Y or N If yes, in what?

Are you Pre-Health? Y or N If Yes: Pre-Med Pre-Pharm Pre-Dental

Did you transfer to USC from another College? Y or N If yes, from where?

Are you a student athlete? Y or N

Are you involved in any USC clubs and organizations? Y or N

Are you a member of a Fraternity or Sorority? Y or N

Are you the first person in your family to attend college? Y or N

Are you the recipient of any USC scholarships? Y or N If yes, which ones?

Are you a Merit Research student? Y or N

Do you have a job? Y or N If yes, how many hours per week?

Are you currently conducting research? Y or N If yes, which professor?

Do you have obligations other than school and work? Y or N

Ethnicity: (circle all that apply)

Asian Black/African American Caucasian

Latino/Hispanic Native American Other

What did you do this summer?

Do you have any suggestions or ideas that would improve your advisement experience?

What are your post-graduation plans?

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