Free_app

I authorize the Big Ten Academic Alliance to share my personal and educational data that I provide using this online form. My information will be distributed to Big Ten Academic Alliance universities. This consent applies to education data that may otherwise be protected under the federal Family Educational Rights and Privacy Act of 1974, as amended, 20 U.S.C. 1232g, also known as FERPA or the Buckley Amendment. This authorization will remain in effect until I rescind it in writing.*

I AgreeI Decline
The Big Ten Academic Alliance collects FreeApp requests on behalf of the participating Big Ten Academic Alliance universities. Without your permission to share your data, we cannot process a request for you. If you have any questions, contact the FreeApp Coordinator at freeapp.coordinator@btaa.org.

FreeApp

Waiver Request Form
Do you have a 3.0 G.P.A. or greater (on a 4.0 scale or equivalent)?*

YesNo
You must have a G.P.A of 3.0 or greater to continue
Are you currently a U.S. citizen or permanent resident?*

YesNo
You must be a U.S. citizen or permanent resident to continue

Name

First NameLast Name
Name*
First Name
Last Name
Preferred First Name
Middle Initial
Birth Date*

MonthDayYear
Gender*

FemaleMaleNon-binaryTransgenderPrefer not to answerNot 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 CitizenPermanent Resident
Ethnicity (please select any that apply)*

African American or BlackAsianHispanic/LatinoNative American or Alaska NativeNative Hawaiian or Other Pacific IslanderWhitePrefer not to answerNot listed (please specify)
Please specify*
Are you a member or veteran of the United States Armed Services?*

YesNo
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).*

YesNoI don't know
Which best describes the highest education level achieved by a parent or legal guardian?*

Has no high school diploma/GEDHas high school diploma /GEDAttended college, no degreeAssociates degreeBachelors degreeMasters degreeProfessional degreeDoctorate degree
Please select any program in which you are currently participating or have participated in the past.*

AGEPCORHughesLSAMPMARCMBRSMcNairMellon MaysPellRISENot Listed (please specify)
Please specify*
Have you participated in the Summer Research Opportunities Program at a Big Ten Academic Alliance university?*

YesNo
Which Big Ten Academic Alliance university?*
Have you participated in the Summer Research Opportunities Program at more than one Big Ten Academic Alliance university?*

YesNo
Which Big Ten Academic Alliance university?*
Undergraduate University*
City*
State*
Major*
Department*
Undergraduate GPA (Cumulative)*
Grading Scale*

4.0Other (please specify)
Please specify*
Undergraduate Graduation Date*

MonthDayYear
Are you currently enrolled in Grad School?*

YesNo
Graduate University
City
State
Discipline
Department
Graduate G.P.A
Graduate G.P.A grading scale

4.0Other (please specify)
Please specify*
Check the post-baccalaureate areas that interest you*

MastersM.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 ChicagoUniversity of IllinoisIndiana UniversityUniversity of IowaUniversity of MarylandUniversity of MichiganMichigan State UniversityUniversity of MinnesotaUniversity of Nebraska-LincolnNorthwestern UniversityThe Ohio State UniversityPenn State UniversityPurdue UniversityRutgers University-New BrunswickUniversity of Wisconsin-Madison
For which department or program are you seeking admission?*
Gender_Female

TrueFalse
Gender_Male

TrueFalse
Gender_Non-binary

TrueFalse
Gender_Transgender

TrueFalse
Gender_Prefer not to answer

TrueFalse
Gender_Not Listed (please specify)

TrueFalse
Ethnicity_African American or Black

TrueFalse
Ethnicity_Hispanic

TrueFalse
Ethnicity_Asian

TrueFalse
Ethnicity_Native American or Alaska Native

TrueFalse
Ethnicity_Native Hawaiian or Other Pacific Islander

TrueFalse
Ethnicity_Prefer not to answer

TrueFalse
Ethnicity_White

TrueFalse
Ethnicity_Not listed (please specify)

TrueFalse
underrepresented populations_COR

TrueFalse
underrepresented populations_Hughes

TrueFalse
underrepresented populations_LSAMP

TrueFalse
underrepresented populations_MARC

TrueFalse
underrepresented populations_MBRS

TrueFalse
underrepresented populations_McNair

TrueFalse
underrepresented populations_Mellon Mays

TrueFalse
underrepresented populations_RISE

TrueFalse
underrepresented populations_Not Listed (please specify)

TrueFalse
Prog1

TrueFalse
Prog2

TrueFalse
Prog3

TrueFalse
Prog4

TrueFalse
fee waiver_University of Chicago

TrueFalse
fee waiver_University of Illinois

TrueFalse
fee waiver_Indiana University

TrueFalse
fee waiver_University of Iowa

TrueFalse
fee waiver_University of Maryland

TrueFalse
fee waiver_University of Michigan

TrueFalse
fee waiver_Michigan State University

TrueFalse
fee waiver_University of Minnesota

TrueFalse
fee waiver_University of Nebraska-Lincoln

TrueFalse
fee waiver_Northwestern University

TrueFalse
fee waiver_The Ohio State University

TrueFalse
fee waiver_Penn State University

TrueFalse
fee waiver_Purdue University

TrueFalse
first gen_level undergrad

TrueFalse
first gen_Grad

TrueFalse
fee waiver_Rutgers University-New Brunswick

TrueFalse
fee waiver_University of Wisconsin-Madison

TrueFalse
underrep_Pell

TrueFalse
Undergrad_4.0

TrueFalse
Undergrad_other

TrueFalse
Citizen_US

TrueFalse
Citizen_PermRes

TrueFalse
GradScale_40

TrueFalse
GradScale_Other

TrueFalse
AGEP

TrueFalse
Low
Should be Empty:

FreeApp

You must have a G.P.A of 3.0 or greater to continue

You must be a U.S. citizen or permanent resident to continue