(Applications are accepted on a continuous basis. Only those students with a 3.0 undergraduate GPA and a 3.5 or above graduate GPA will be considered. Complete the following form and Mail to: Director - PhD. Program; College of Engineering - Room 910; University of New Orleans; New Orleans, LA 70148.)

Name ______________________________________________________________________
                        Last                                                        First                                                           Middle

Social Security No. _______________________________ Phone No. ____________________

Address _____________________________________________________________________
                            No.             Street                                             City                                         State                         Zip Code

Date of Birth __________________________ Place of Birth ____________________________

Citizenship (country) _______________ If not U.S. Citizen, Immigration Status _______________

Sex _________________ Race ___________________ Marital Status ____________________

Highest Degree Received ________________ Date Awarded or Expected __________________

Name of University Awarded Degree _______________________________________________

GPA: ______(B.S); _______(M.S);    TOEFL ______    GRE (______) (______) (______)
                                                                                                     Score                           Verbal        Quantitative      Analytical

(Please check type of assistantship for which you are applying) _______Teaching; _______Research

Area of Interest________________________________________________________________

____________________________________________________________________________
                                Your Signature                                                                                                                  Date