Student Inquiry Form

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If you are interested in applying to CEA-CREST or UMEB, you must initially complete a CEA-CREST / UMEB Inquiry Form. Upon the submission and the review of your inquiry form, a CEA-CREST or UMEB faculty or staff member will contact you within one to three weeks. Eligible, qualified students will then be invited to submit a full CEA-CREST or UMEB application form.

To learn more about our program of student support, please submit this form to CEA-CREST. While providing this information is voluntary, it will help us keep track of student requests. Thank you.
Note: You must be a citizen or permanent resident. * Denotes required field

* Name:

Mr.

Ms.

* First: * Last:

* Address:

* City:

* State:

* Zip:

* Email address:

* Telephone:

* U.S. Citizen: Yes

Permanent Resident (registration number)

Social Security Number:

Ethnicity:

(check one)

		African American
		American Indian / Native American; Tribe
		Asian
		Caucasian / White
		Hispanic / Chicano(a) / Latino(a)
		Pacific Islander
		Other (identify)

* Last school attended or currently attending:
Current or Highest Completed Class Standing:
	Freshman Sophomore Junior Senior Graduate
Graduation date or anticipated:

Month / Year

Degree

Major

*GPA (last 90 quarter units or last 60 semester units)

* CSULA students only: - I authorize the program to verify my GPA	Yes No
*** Non-CSULA Students: Please mail or FAX a copy of Official Transcripts from all higher education schools you have attended to the attention of the Program Assistant, (323) 343-5799.
Are you currently conducting research with faculty at CSULA?	Yes No
If yes, name of faculty:
* Would you be applying to CSULA as an undergraduate or master's student?

Graduate

Undergraduate


Please describe your personal research interests.	Please describe your research experience, including skills acquired.


What is your career goal?	Is there a particular CEA-CREST faculty member or members with whom you are interested in working? To select more than one faculty member: For PC, hold down Ctrl key For Mac, hold down Shift key

How did you hear about CEA-CREST?

Thank you for inquiring into the CEA-CREST and UMEB programs here at California State University, Los Angeles. We will be contacting you soon.