Course Application

Personal Information
Name
Local / Campus Address
City
State	--Select a State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip
Phone
Email
PUID
Purdue Status
School Department
Level	-- Select a Level -- Graduate Undergrad, Jr., Sr. Undergrad, Fresh, Soph Other
If Other
Educational Background
School Degree Year Major Undergrad Graduate Other
Question
Please describe in 250 words or fewer Your motivation and inspiration behind this application and your specific interests in the program. Describe how you see yourself benefiting and contributing to this unique multidisciplinary program