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College of Engineering
Application for Pariticipation in a
Combined Degree Program

Please enter all information and submit this form.

First Name:

Last Name:

Date:

Student ID#:

Email:

Please select your College of Engineering Major

Biomedical Chemical Civil Electrical Industrial Mechanical Undeclared

Liberal Arts Major:

Minor:

UI GPA:

# of semester hours earned toward degree:

Engineering Faculty Advisor:

Liberal Arts Advisor:

Thank you! Your form will be submitted to the Academic Info & Forms Manager, Megan Allen.