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2025-2026 UCI-HBCU Summer Research Program Application

Full Legal Name (First M. Last)

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Overall GPA

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Expected Year of Graduation (month, year)*

*Note: You must plan to graduate within the year following the summer program.

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Phone Number (cell)

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Your University (please check one)

North Carolina Central University (NCCU)

North Carolina Agricultural and Technical State University (NC A&T)

Winston-Salem State University (WSSU)

Faculty Sponsor Name (First M. Last)

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