PURE BLISS Application

Your Contact Information

Name*

First Last

Date of Birth*

CWID

Race/Ethnicity

Select all that apply

Gender*

Male
Female

Status*

Only US Citizens or permanent residents are permitted in the program and, therefore, eligible to apply.

U.S. Citizen
Permanent Resident

Do you have a passport that is valid until 1/31/2026?

Yes
No

Do you speak Portuguese?

Yes
No

If yes, what level of proficiency?

Have you ever traveled abroad?

Yes
No

If yes, which country(ies) and when?

Are you a first-generation college student?

A first-generation college student is defined as a student whose parent(s)/legal guardian(s) have not completed a bachelor's degree. This means that you are the first person in your family to attend a four-year college/university to attain a bachelor's degree.

Yes
No

Have you passed CHE 445?

Yes
No

Have you passed CHE 416 or CHE 418?

Yes
No

If no, are you willing and able to take this course in Spring 2025?

Yes
No

Do you currently do undergraduate research at UA?

Yes
No

If YES, which labs(s) and department(s)? How many semesters? Any other research experience (e.g., REU?)

Email*

Current Phone Number

Preferably a cell phone

Permanent Phone Number

Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Permanent Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Academic Information

Current Class Standing

GPA

Major(s)

Minor(s)

Expected Graduation Date

Preferred Research Project

List, in order, your three preferred research projects as described on the projects page.

Project 1*

Project 2*

Project 3*

More About You

Personal Statement

Briefly describe your background, experience, and interest in the program.

Interest in the Program

Briefly describe your interest in the program.

Your Goals

Briefly describe your goals over the next five years.

Career Goals

Briefly describe your career goals.

References

Please provide the e-mail address for the requested number of references.
References will only be contacted as part of the final selection process.

Reference 1 Name*

Reference 1 Email*

Transcript

Select a transcript file to upload*

Accepted file types: pdf, doc, docx, Max. file size: 10 MB.

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