12/4/2014

iFoundryTechnologyEntrepreneurCenterInnovationCertificateApplication201415,IL

iFoundryTechnologyEntrepreneurCenterInnovation
CertificateApplication201415
PersonalInformation
1.Areyouafirstyearorfreshmanstudent?(Studentsmustbefirstyearorfreshmenstudentstoapplyforthisprogram.
ThiscertificateprogramisdesignedforEngineeringstudents,butstudentsfromothermajorsmayapplytobeconsidered).

yes
no
2.Name

3.Address

4.PhoneNumberwithareacode

5.Emailaddress

6.Gender

7.Locationofthehighschoolyouattended/graduatedfrom

PleaseinsertyourUniversityIdentificationNumber
8.UIN#

limitedto9characters.

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iFoundryTechnologyEntrepreneurCenterInnovationCertificateApplication201415,IL

9.WhatdepartmentintheCollegeofEngineeringhaveyoubeenadmittedto?

10.AreyouenrolledinorhaveyoucompletedanIEFXENG101,191,or198courseforFall2014?

Yes
No
11.IfYes,whichcourseareyouenrolledin?

ENG101EngineeringatIllinois
ENG191InternationalDimensionsofEngineering
ENG198Inspiring,InteractingandInformingTheSecretWeaponsofanEngineeringLeader
ENG198IEFXProjects
ENG198EssentialsinMATLABandExcel
ENG198EngineeringforGlobalDevelopment
ENG198RenaissanceEngineer
ENG198IEFXResearch
ENG198GrandChallenges
ENG198StrategiesforInternationalDevelopment
ENG198DecodingDr.Dre:AdventuresinUrbanEngineering
ENG198FirstYearWomenEngineers
Other

12.ListyourprimaryclubsandactivitiesinhighschoolandattheUniversityofIllinois.

ShortAnswerEssayQuestions
Pleaseanswerallquestions.
13.WhathasinspiredyoutopursuetheiFoundry/TechnologyEntrepreneurCenterInnovationCertificateopportunity?
(50100words)

14.Beyondthemathsciencecoursesthatcomposeyourcurriculum,whatareyoumostcuriousaboutlearningand
why?Youranswercanincludecourses,books,art,people,fieldsofstudy,oranythingelsethatexcitesyourcuriosity.
(50100words)

15.BuildingcommunityandinteractingwithotherswillbeamajorpartoftheInnovationCertificateprogram.Please
tellus:a.WhatyoubringtothecommunityofInnovationCertificatestudents,teachers,andindustrypartners(50
words)b.Whatyouhopethecommunitywillbringtoyoureducationandlife?(50words)
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iFoundryTechnologyEntrepreneurCenterInnovationCertificateApplication201415,IL

16.Isthereanythingelseyouwouldlikeustoknowaboutyou?

YournetIdwillbeattachedtotheresultsofthiswebform.
FormprovidedbyWebServicesinPublicAffairs|logout

UniversityofIllinoisatUrbanaChampaign

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