College Surveys

University of Chicago

MBL Spring Quarter 2022 Application - Neuroscience

Please submit this form by the due date listed on the website. Contact Elizabeth Baldo at elbaldo@uchicago.edu with questions.

First Name *

Last Name *

8-digit student ID number *

UChicago Email *

Year of Study for the 2021-2022 Academic Year *

First Year

Second Year

Third Year

Fourth Year

Major(s) / Intended Major(s) *

Minor(s)

Academic Advisor Name *

Academic Advisor Email *

Would you like to be considered for need-based financial aid? *

Yes

Location you will be traveling from to get to MBL (City and State, and Country if not the US) *

Your Cumulative GPA

Module 1 Course *

Please select the course you would like to take during module 1. You may only take one course per module.

Fundamentals of Synapses

Physics III

Modle 2 Course *

Cell & Molecular Biology of the Brain

Imaging for Biological Research

Module 3 Course *

Dynamic Camouflage

Would you like to take the optional arts course, On Images? *

Yes

Not Sure

You would take this course in addition to the courses you will take in the first two modules.

Briefly describe why you would like to participate in the MBL Spring Quarter Program. *

Typical responses are between 200 and 500 words, however you are welcome to submit a longer response if you would like to.