Name: ____________________________________________________________________________________
              LAST OR FAMILY                         FIRST NAME                                               MIDDLE NAME

             ____________________________________________________________________________________
             OTHER NAME(S) THAT MAY APPEAR ON YOUR EDUCATIONAL RECORDS

U.S. Social Security Number  :____________________________________ Date of Birth: __________/__________/__________
                                                                                                                                                                      MONTH        DAY           YEAR

Of which country are you a citizen? ______________________    Date of entry into U.S.A. _____________________

                                                                    *[ ] Permanent Resident     [ ] F-1
Type of visa you hold  [] or will hold [] :       [ ] Diplomat                    [ ] J-1        [ ] Other (please specify) _________________________
(Check one)

^{*It is necessary for you to provide official documentation of  permanent residency status for student billing purposes .}

Place of Birth:_____________________________________________________________________________________
                             STATE                                            COUNTRY

Mailing Address: (Address to which all correspondence should be mailed)               Until what date:____________________________

_________________________________________________________________________________________________________
NUMBER AND STREET

_________________________________________________________________________________________________________
CITY                                                    STATE OR PROVINCE                                       COUNTRY                                      MAIL CODE

Daytime Telephone Number:_________________________________________________
                                              AREA CODE AND NUMBER

Permanent Home Address:

_________________________________________________________________________________________________________
NUMBER   AND   STREET

_________________________________________________________________________________________________________
CITY                                                    STATE OR PROVINCE                                      COUNTRY                                      MAIL CODE

Phone:  ________________________________________                        E-mail:  ___________________________________________
AREA CODE AND NUMBER

FAX  :  _______________________________________
 

Doctoral or master's program(s) to which you have applied:     [ ]CUNY       [ ]Cornell       [ ]Fordham       [ ]NYU       [ ]Columbia     [ ]Yale

State your desired specialization within the field of botany:  ____________________________________________________________

List all colleges and universities attended, NYBG requires one official transcript from each institution. Indicate the most recent school first.

NAME OF                                         LOCATION                           PERIOD OF ENROLLMENT       MAJOR        DEGREE OR   DATE CONFERRED
EDUCATIONAL INSTITUTION      CITY, STATE, COUNTRY         FROM             TO                                        DIPLOMA       OR EXPECTED
                                                                                                          MONTH/YEAR MONTH/YEAR

  Special academic honors, including fellowships, honor societies, or other evidence of significant scholarship.

Published work (include title, date, and place of publication), patents, research in progress, and other original work. If necessary, attach list on separate page.

Employment:
PERIOD OF EMPLOYMENT         NAME OF FIRM OR                     ADDRESS                                          POSITION                           DUTIES
FROM              TO                           ORGANIZATION                          CITY, STATE, COUNTRY
MONTH/YEAR MONTH/YEAR

Native Language: 

Please describe your foreign language ability:

LANGUAGE                                                                                 READING ABILITY   SPEAKING ABILITY   WRITING ABILITY
                                                                                                        GOOD FAIR POOR     GOOD FAIR POOR     GOOD FAIR POOR

___________________________________________                   ____   ____   ____        ____   ____   ____        ____   ____   ____

___________________________________________                   ____   ____   ____        ____   ____   ____        ____   ____   ____

___________________________________________                   ____   ____   ____        ____   ____   ____        ____   ____   ____

List three persons who know your academic qualifications and potential for graduate study, including at least one instructor at the institution you last attended. Ask each person to send a personal letter to the Manager of Graduate Studies at The New York Botanical Garden.

RECOMMENDER    NAME                                               POSITION               ADDRESS (CITY, STATE, COUNTRY)

1

2

3

Test Scores
                         DATES TAKEN OR EXPECTED                              RESULTS

TOEFL:            _____________________________                  ____________________________

GRE General:   ____________________________                 Verbal  ______________________       _______________%

                                                                                                       Quantitative ___________________        _______________%

                                                                                                        Analytic _____________________        _______________%
GRE Subject:

Test (Optional)   ____________________________                    Score_________________________          _______________%

                                                                                                       Subscore______________________           _______________%

                                                                                                       Subscore______________________           _______________%
Other Information

Please list other universities to which you are applying.

_________________________________________            _________________________________________

_________________________________________             _________________________________________

Please give the names and professional affiliations of individuals most responsible for your decision to apply to The New York Botanical Garden Graduate Program.

_________________________________________        ___________________________________________________________

_________________________________________        ___________________________________________________________

I certify that I have read and understood all instructions accompanying this application and have answered all questions truthfully to the best of my knowledge. I understand that any misrepresentation or omission may be cause for denying fellowship support. I understand that this application and all materials received in support of it become the property of The New York Botanical Garden and will not be duplicated or returned to me for any reason. Furthermore, I understand that The New York Botanical Garden reserves the right to deny funding to any student at any time for any reason it considers sufficient, including scholarship, character, and personal conduct.

Date:_______________________________                             Signature:_________________________________________________

New York Botanical Garden is an affirmative action/equal opportunity institution and considers all persons without regard to age, gender, color, ethnic background, sexual orientation, handicap, or religious preference.
 

                                                                                                            Statement of Purpose
 

Name:

Please describe briefly your reasons for undertaking graduate study, your educational objectives, and your career plans. What particular aspect of your field of study do you find the most interesting? Your most recent curriculum vitae may be used to supplement your statement. (If additional paper is required, please note your full name on each sheet).
 
 





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