FreeApp
Waiver Request Form
Do you have a 3.0 G.P.A. or greater (on a 4.0 scale or equivalent)?
*
Yes
No
You must have a G.P.A of 3.0 or greater to continue
Are you currently a U.S. citizen or permanent resident?
*
Yes
No
You must be a U.S. citizen or permanent resident to continue
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Name
First Name
Last Name
Name
*
First Name
*
Last Name
Preferred First Name
Middle Initial
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
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1975
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1971
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1967
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1965
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1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Female
Male
Non-binary
Transgender
Prefer not to answer
Not Listed (please specify)
Please specify
*
Address Line 1
*
Address Line 2 (Optional)
Address City
*
Address State
*
Address Zip Code
*
Email Address
*
Phone Number
*
Phone Number
Citizenship Status
*
US Citizen
Permanent Resident
Ethnicity (please select any that apply)
*
African American or Black
Asian
Hispanic/Latino
Native American or Alaska Native
Native Hawaiian or Other Pacific Islander
White
Prefer not to answer
Not listed (please specify)
Please specify
*
Are you a member or veteran of the United States Armed Services?
*
Yes
No
When applying to college, the annual household income of my parents or primary care-givers made me eligible for income-based federal or state aid (e.g., Pell Grants, Subsidized Student Loans, Other State/Federal Grants).
*
Yes
No
I don't know
Which best describes the highest education level achieved by a parent or legal guardian?
*
Has no high school diploma/GED
Has high school diploma /GED
Attended college, no degree
Associates degree
Bachelors degree
Masters degree
Professional degree
Doctorate degree
Please select any program that you are or have been a participant in that supports underrepresented populations.
*
AGEP
COR
Hughes
LSAMP
MARC
MBRS
McNair
Mellon Mays
Pell
RISE
Not Listed (please specify)
Please specify
*
Have you participated in the Summer Research Opportunities Program at a Big Ten Academic Alliance university?
*
Yes
No
Which Big Ten Academic Alliance university?
*
Please Select
University of Chicago
University of Illinois
Indiana University
University of Iowa
University of Maryland
University of Michigan
Michigan State University
University of Minnesota
University of Nebraska-Lincoln
Northwestern University
The Ohio State University
Penn State University
Purdue University
Rutgers University-New Brunswick
University of Wisconsin-Madison
Have you participated in the Summer Research Opportunities Program at more than one Big Ten Academic Alliance university?
*
Yes
No
Which Big Ten Academic Alliance university?
*
Please Select
University of Chicago
University of Illinois
Indiana University
University of Iowa
University of Maryland
University of Michigan
Michigan State University
University of Minnesota
University of Nebraska-Lincoln
Northwestern University
The Ohio State University
Penn State University
Purdue University
Rutgers University-New Brunswick
University of Wisconsin-Madison
Undergraduate University
*
City
*
State
*
Major
*
Department
*
Undergraduate GPA (Cumulative)
*
Grading Scale
*
4.0
Other (please specify)
Please specify
*
Undergraduate Graduation Date
*
 -
Month
 -
Day
Year
Are you currently enrolled in Grad School?
*
Yes
No
Graduate University
City
State
Discipline
Department
Graduate G.P.A
Graduate G.P.A grading scale
4.0
Other (please specify)
Please specify
*
Check the post-baccalaureate areas that interest you
*
Masters
M.F.A.
Ph.D.
M.D./Ph.D.
Please indicate which university you would like to receive a fee waiver from (check all that apply).
*
University of Chicago
University of Illinois
Indiana University
University of Iowa
University of Maryland
University of Michigan
Michigan State University
University of Minnesota
University of Nebraska-Lincoln
Northwestern University
The Ohio State University
Penn State University
Purdue University
Rutgers University-New Brunswick
University of Wisconsin-Madison
For which department or program are you seeking admission?
*
Gender_Female
True
False
Gender_Male
True
False
Gender_Non-binary
True
False
Gender_Transgender
True
False
Gender_Prefer not to answer
True
False
Gender_Not Listed (please specify)
True
False
Ethnicity_African American or Black
True
False
Ethnicity_Hispanic
True
False
Ethnicity_Asian
True
False
Ethnicity_Native American or Alaska Native
True
False
Ethnicity_Native Hawaiian or Other Pacific Islander
True
False
Ethnicity_Prefer not to answer
True
False
Ethnicity_White
True
False
Ethnicity_Not listed (please specify)
True
False
underrepresented populations_COR
True
False
underrepresented populations_Hughes
True
False
underrepresented populations_LSAMP
True
False
underrepresented populations_MARC
True
False
underrepresented populations_MBRS
True
False
underrepresented populations_McNair
True
False
underrepresented populations_Mellon Mays
True
False
underrepresented populations_RISE
True
False
underrepresented populations_Not Listed (please specify)
True
False
Prog1
True
False
Prog2
True
False
Prog3
True
False
Prog4
True
False
fee waiver_University of Chicago
True
False
fee waiver_University of Illinois
True
False
fee waiver_Indiana University
True
False
fee waiver_University of Iowa
True
False
fee waiver_University of Maryland
True
False
fee waiver_University of Michigan
True
False
fee waiver_Michigan State University
True
False
fee waiver_University of Minnesota
True
False
fee waiver_University of Nebraska-Lincoln
True
False
fee waiver_Northwestern University
True
False
fee waiver_The Ohio State University
True
False
fee waiver_Penn State University
True
False
fee waiver_Purdue University
True
False
first gen_level undergrad
True
False
first gen_Grad
True
False
fee waiver_Rutgers University-New Brunswick
True
False
fee waiver_University of Wisconsin-Madison
True
False
underrep_Pell
True
False
Undergrad_4.0
True
False
Undergrad_other
True
False
Citizen_US
True
False
Citizen_PermRes
True
False
GradScale_40
True
False
GradScale_Other
True
False
AGEP
True
False
Low
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