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Summary: University of Georgia
Biomedical and Health Sciences Institute
Neuroscience Program
STATEMENT OF INTEREST
NAME:________________________________________________________________________
CURRENT ADDRESS:___________________________________________________________
_______________________________________________________________________________
PHONE NUMBER:____________________________ EMAIL:_________________________
CITIZENSHIP:___________________
AREA OF INTEREST:
EDUCATIONAL BACKGROUND
SCHOOL/LOCATION DATES ATTENDED DEGREE/YEAR
__________________________________ ____________________________ ________________
__________________________________ ____________________________ ________________
__________________________________ ____________________________ ________________
OVERALL UNDERGRADUATE GPA___________ MAJOR___________________________
OVERALL GRADUATE GPA_____________ MAJOR___________________________
Select One
TEST SCORES
GRE: VERBAL______ QUANTITATIVE______ TOTAL______ DATE TAKEN________
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