IGERT Student Participant Data Form – UCSD

Name:  ______________________________________

Ethnicity:  ___________________________________  Gender:  ________

Home Department:  ___________________________

Advisor:  ____________________________________

Thesis topic (if available):

e-mail address:  _______________________________

Please provide the following information about your prior degrees:

Degree	Date Degree was Awarded	
Awarding Institution	
Major Area(s)	

				

When did you begin your graduate training UCSD? (please provide month and year)

In what years did you receive IGERT financial support, and how do these correspond to your year in graduate school?

Year of IGERT Support (2000-2001, 2001-02)	Year in graduate training (1st, 2nd, etc) 	

		

What sources of funds other than IGERT have supported you during your graduate study at UCSD? (Please list the source of funds and the months/year during which you received the funding.)

Source of Funds	Period of Funding (e.g. 9/2000 – 5/2001) 	

		

Please list any publications or patents that you have from your graduate study at UCSD.

If applicable, please list the date, degree earned, and/or reason for the termination of this graduate program, as well as your current activities (e.g. employed by….)