Preliminary Application for Graduate Study

Last name

First name

M.I.

male female

Street Address

Apt. No.

Date of Birth

City

State/Country

ZIP

Citizenship

Home Phone Number

FAX

E-mail Address

Intended Field of Study (please indicate area of interest)

1. Application Computer Science Chair

Computer Science
Information design technology

2. Software Engineering Chair

3. Computer Information Technologies Chair

Computer Science
Software Engineering
Internet Software

Computer Science
Information Control Systems and Technologies

Educational Record (please include copies of transcripts, resume, GRE and TOEFL scores, if taken. Also attach a list of publications, if any. Knowledge of Ukrainian or Russian)

Institution (City/State/Country)

Dates Attended

Major

Degree

Final Average

Standardized Exam Scores (Include copies if available)

GRE Score

TOEFL Score

Applying For

Fall term 2001(September)

Date Taken