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					Departmental Supplement
Department of Architecture and Urban Design application deadlines for Fall Quarter 2012: December 15 for all master's and Ph.D.
programs

To be considered for Departmental and University fellowships you must submit a complete dossier (including transcripts and letters of
recommendation) by the above dates. Incomplete applications will not be reviewed for fellowships. The application form, lett ers of
recommendation, and transcripts will not be individually acknowledged, but applicants will be sent one postcard or email during the
admissions process to notify them as to their status. When all of the application materials for the Department and for the Graduate
Division have been received, the file will be reviewed and applicants will be notified of the decision taken in their case.

This is not an application form for admission to graduate standing at UCLA. When applicants are accepted by the Department of
Architecture and Urban Design, they must also meet admission requirements of the Graduate Division before being admitted. See the
Departmental Brochure for more details about application procedures.
                                                                  nd
NOTE: Before completing, read the privacy notification on the 2 page of this form. This form should be mailed directly to Department
of Architecture and Urban Design Admissions Office, UCLA School of the Arts and Architecture, Box 951467, Los Angeles, CA 90095-
1467.

Personal Data
                                                                                            Date ____________________________

Name _____________________________________________________________________________________ Sex _______
                Last                               First                                       Middle                             M or F

Birthplace ___________________________ Date of Birth ____________________ Country of Citizenship__________________

Mail Address for Answer ___________________________________________________________________________________
(until            )         Street and Number          City, State, and Zip                  Telephone
        Date

Permanent Home Address _________________________________________________________________________________
                               Street and Number                    City, State, and Zip                             Telephone

Email Address ___________________________________________________________________________________________


Present Occupation/Place of Employment _____________________________________________________________________
                                                                                                                           Telephone

Application for the academic year beginning Fall Quarter 20_____


Are you applying to other graduate programs? ______           If so, list: _________________________________________________

______________________________________________________________________________________________________

Have you applied to this program before? ______            If so, when: ______________________________________________ ____

Major Code and Degree Objective

Check one only:
   Major Code                Degree
     084                               Master of Architecture, First Professional Degree (M.Arch.l)

     084                               Master of Architecture, Second Professional Degree (M.Arch.II)

     084                              Master of Arts (M.A.) in Architecture

     084                              Doctor of Philosophy (Ph.D.) in Architecture

     DAD                              Master of Architecture, First Professional Degree / M.A. in Urban Planning
                                            Concurrent Degree Program



                                        (Departmental Supplement continued on back)
Academic/Professional Data

List chronologically all colleges, universities, and other educational institutions attended since high school, including mil itary or
other service programs (if academic credit given), extension or correspondence courses, and school currently attending.

   Name of School, College, or Service           Location              Dates of                Major           Type of     Date Rec’d
               Program                                                Attendance                               Degree      or Expected




Applicant's Signature _________________________________________________________________________________________________




How did you find out about the Department of Architecture and Urban Design at UCLA? ________________________________




Privacy Notification

The State of California Information Practices Act of 1977 requires the University to provide the following information to individuals who
are asked to supply information about themselves. The principal purpose for requesting the information on this form is to evaluate
eligibility for admission to the Department of Architecture and Urban Design. University Policies authorize maintenance of this
information.

Furnishing all information requested on this form is mandatory; failure to provide such information will delay or may even prevent
completion of the action for which the form is being filled out. Information furnished on this form may be used by various University
departments for admission, registration, and administration of fellowships and financial aid and will be transmitted to the State and
Federal government if required by law.

You have the right to review personal information maintained about you in accordance with University Policies and may contact either
the office of record maintaining such information or the Records Management Coordinator, Room 200, Campus Services Building II,
for more information concerning your rights.

The official responsible for maintaining the information contained on this form is the Admissions Officer, Department of Architecture
and Urban Design, UCLA School of the Arts and Architecture, Box 951467, Los Angeles, CA 90095-1467.

				
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