UMGRAD_56838489_20141210063815

8/10/2019 UMGRAD_56838489_20141210063815

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HORACE H. RACKHAM SCHOOL OF GRADUATE STUDIES

UNIVERSITY OF MICHIGAN

Online Application 2014-2015

Parent #2 was a citizen or a permanent resident of the U.S. at the time I

was born.

Visa Information (Non-U.S. Citizens only)

U.S. Visa type you plan to use or obtain

Will you have dependents accompanying you to Michigan?

If currently in the United States, Visa type:

SEVIS ID Number:

Name of the institution/organization that issued the I-20 or DS-2019

Race/Ethnicity (For U.S. Citizens and Permanent Residents only)

Please indicate whether you consider yourself to be Hispanic or Latino.

Yes, Hispanic or Latino

No, not Hispanic or Latino

In addition, select one or more of the following racial categories to de-

scribe yourself:

American Indian or Alaska Native

Asian Black or African American

White

U.S. Military Service

On active duty U.S. military

Veteran of U.S. armed forces

U.S. Reserves or National Guard

U.S. Military Dependent

Parent’s Education Information

Parent #1 highest educational level completed

Parent #2 highest educational level completed

Graduate Program Information

Intended Graduate Program

Subplan

Proposed Term/Year of Enrollment

Applying to more than one Rackham Program

Are you applying to more than one Rackham program?

Rackham program 2

Rackham program 3

Applying to Dual Degree

Are you applying to a dual degree program with a non-Rackham school or

college?

School or College

Application Form - Page 1AcknowledgementI certify that all information in this application is true and complete, and that I am the author of

my Academic Statement of Purpose and Personal Statement. I understand that the University

and credentials may result in the withdrawal of my application or in the revocation of admission,

University of Michigan.

Personal InformationFirst (Given)

Last (Family)

Middle

Other name that appears on prior academic records or test score

reports

Other First Name

Other Last Name

Gender

Birthdate (month/day/year)

Birthplace City

State/Province

Country

Native Language

Previous Enrollment

If you have an 8 digit University of Michigan ID Number, Please

enter it here:

Have you ever taken a class at the University of Michigan - Ann Arbor

Campus?

Are you applying to the Concurrent Undergraduate/Graduate Studies

(CUGS) program?

Have you ever registered for a Rackham class as a Rackham student?

Are you currently registered in a Rackham program as a Rackham

non-degree/guest student?

Are you currently registered in a Rackham Program as a Rackham

Do you intend to complete this program?

If you have a Uniqname issued by the University of Michigan, please

enter it here: @umich.edu

United States Social Security Number

Source of Fee Waiver

Fee Waiver Code

Citizenship Status

Country of Citizenship

(Permanent Residents and Non-U.S. Citizens Only)

U.S. Permanent Resident Registration Number A

For U.S. Citizens and Permanent Residents only

Parent #1 was a citizen or a permanent resident of the U.S. at the time I

was born.

Siddharth Mohan, Biomedical Engineering Ph.D.,, Fall 2015

F1

NoSiddharth

Mohan

Male

07-08-1992

Jaipur

Rajasthan

India

Malayalam

No

Graduate or professional degre

(ex.: M.A., Ph.D., M.B.A. or J.D

Graduate or professional degre

(ex.: M.A., Ph.D., M.B.A. or J.D

Biomedical Engineering Ph.D.

Fall 2015

Non-U.S. Citizen

India

No

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Application Form - Page 2CURRENT Address Information

Address Line 1

Address Line 2

City State/Province

Country

U.S. Zip/International Postal Code

Current untilE-mail

Home Phone Work Phone Ext.

Cell Phone

PERMANENT Address Information Address Line 1

Address Line 2

City State/Province

Country

U.S. Zip/International Postal Code

Phone

Michigan ResidencyResidency Michigan Resident, since Non-Michigan Resident

Education InformationBachelor Degree Institution

Dates Attended to

Location City State/Province

Country

Major Field

Major Field

Degree/Diploma

Level of Education

Degree Date Degree Status

GPA on a scale of

or Pass/Fail International Average

Institution 2

Dates Attended to


Country

Major Field

Major Field

Degree/Diploma

Level of Education


GPA on a scale of


Institution 3

Dates Attended to

Location City State/Province Country

Major Field

Major Field

Degree/Diploma

Level of Education


GPA on a scale of


Institution 4

Dates Attended to


Country

Major Field

Major Field

Degree/Diploma

Level of Education


GPA on a scale of


Institution 5

Dates Attended to


Country

Major Field

Major Field

Degree/Diploma

Level of Education


GPA on a scale of



E-19, Mahawat Khan Road,Railway Qtr

Behind Rouse Avenue

New Delhi Delhi

India

91

X

[email protected]

91-11-23233130

91-9717639950

E-19, Mahawat Khan Road,Railway Qtr

Behind Rouse Avenue

DelhiNew Delhi

India

91

X

000000628

Birla Institute of Technology and Science Pilani

07-201408-2010

RJPilani

IndiaMech Engin - Other

Bachelor of Engineering

Bachelor's

07-2014 Completed

9.04/10

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For U.S. Citizens and Permanent Residents only

Additional College or University Information

Indicate whether you received or will receive a degree from any of the

following institutions in the U.S.: (select all that apply)

Community or Junior College

Historically Black College or University

Predominantly Latino or Latina-Serving College or University

Single-Gender College

Tribal School or College None of the above

Language 1

Native speaker? Able to translate?

Speaking Writing

Years of study in high school

Terms of study in college

Additional experience

Language 2


Speaking Writing




Language 3


Speaking Writing




Language 4


Speaking Writing




Application Form - Page 3

Language 5


Speaking Writing




Language 6


Speaking Writing




Awards/ Scholarships Information

Awards/ Scholarships 1

Institution

Dates or Academic Year /

Awards/ Scholarships 2

Institution

Dates or Academic Year /

Activities InformationSince graduating from high school, have you pursued any volunteer activi-

ties, work experiences, or leadership of student organizations that were

based on race, ethnicity or gender, or to improving race relations in the

U.S.?


English

Yes Yes

High High

High High

throughout

English

DAAD WISE Scholarship

Open Competition

05-2013

Vamsikrishna Pendyala Memorial

BITS-Pilani

05-2012

X

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For U.S. Citizens and Permanent Residents only:

If you attended a U.S. college or university, indicate whether you have

participated in any of the following programs that encourage students to

pursue graduate education: (select all that apply)

Bridges to the Baccalaureate

Committee on Institutional Cooperation: Summer Research

Opportunity Program (CIC – SROP)

Gates Millennium Scholars Program

Graduate Engineering and Science Fellowships for Minorities (GEM)

Institute for Recruitment of Teachers (IRT)

Louis Stokes Alliance for Minority Participation (LSAMP)

Mellon Mays Undergraduate Fellowship

Minority Access to Research Careers (MARC)

Post-baccalaureate Research Education Program (PREP)

Project 1000

Ralph Bunche Summer Institute

Ronald E. McNair Post-Baccalaureate Achievement Program

Public Policy and International Affairs Program (PPIA)

Western/National Name Exchange (NNE)

None of the above

Employment/Work Experience Information

Name of Employer 1

Position/Title

City State/Province

Country

Current Employee Dates: from to

Name of Employer 2

Position/Title

City State/Province

Country


Name of Employer 3

Position/Title

City State/Province

Country


Name of Employer 4

Position/Title

City State/Province

Country


Application Form - Page 4Financial Assistance Information

1. During your undergraduate study, did you receive a Pell Grant from

the U.S. Government? (For U.S. Citizens and Permanent Residents

only) Yes No

2. While you were an undergraduate student, did you work to pay at least

some of the cost of your undergraduate tuition, books and housing?

(Do not include work you did to pay for other expenses such as meals,

transportation or entertainment.) Yes No

for the total cost of your undergraduate education (tuition, housing,

books)?

Other Information

If you are applying to other graduate institutions at this time, please indi-

cate which one(s) here

Optional

I give permission to the following person to contact the graduate program

on my behalf during the application process: (optional)

First Name, Last Name

Relationship


X

1 = little/none

Andreas Richter,TU DresdenResearch Intern

Dresden

Germany

07-201305-2013

Siva Vanapalli, Texas Tech Uni

Research Intern

StanfordTX, TexasLubbock

CaltechUnited StatesCornell

07-201401-2014

Supreet Singh Bahga,IIT Delhi

Research Intern

New Delhi Delhi

Smita PaulIndia

father's sister10-2014 06-2015X

8/10/2019 UMGRAD_56838489_20141210063815





Recommendations

Recommender 1

First Name

Last Name

Title

Institution/Company

Address, line 1

Address, line 2

City

State Postal Code

Country

Phone

E-Mail

Do you waive the right to view the recommendation?

Use online recommendation system?

Recommender 2

First Name

Last Name

Title

Institution/Company

Address, line 1

Address, line 2

City

State Postal Code

Country

Phone

E-Mail



Recommender 3

First Name

Last Name

Title

Institution/Company

Address, line 1

Address, line 2

City

State Postal Code

Country

Phone

E-Mail



Recommender 4

First Name

Last Name

Title

Institution/Company

Address, line 1

Address, line 2

City

State Postal Code

Country

Phone

E-Mail



Additional Information


IndiaSiva

+91-1596-515664Vanapalli

[email protected] Professor

YesTexas Tech Univesity

YesDept of Chemical Engineering ,TTU,Lubbock-79409-3121

Lubbock

79409TX

United States

001-806-7421757

[email protected]

Yes

Yes

Niti Nipun

Sharma

Professor

BITS Pilani,India

Mechanical Engineering Dept,BITS Pilani,Pilani

Rajasthan,India -333031

Pilani

Rajasthan 333031

India

+91-1596-245073

[email protected]

Yes

Yes

Dipendu

Bhunia

Assistant Professor

BITS Pilani,India

Civil Engineering Dept,BITS Pilani,Pilani

Rajasthan,India -333031

Pilani

Rajasthan

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UNIVERSITY OF MICHIGANBiomedical Engineering

Description of Interests Form

In addition to including the following information

in your Statement of Purpose, please complete

the following.

Research InterestsPlease select and rank your top three

research interests.

Faculty Members

faculty with

whom you are interested in working.

1.

2.

3.

4.


Bio-Micro/Nanotechnology and Molecular Engineering

Tissue Engineering and Biomaterials

Biomechanics

Nikolaos Chronis

Xudong Fan

Joseph Bull

Mark Burns

Michael Meyer

Documents

UMGRAD_56838489_20141210063815