Gates Cambridge Scholarship Declaration of Interest Form

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After reviewing the information at cuse.nd.edu/gates, please complete this form as a next step if you are interested in working with CUSE on an application for the Gates Cambridge Scholarship.

After you submit this form, please submit a resume or vita via email to jthibert@nd.edu with the subject line "Gates Interest Form Resume - [Your Last Name, Your First Name]". CUSE will then follow up with you within a week. If you do not hear from CUSE, feel free to follow up at jthibert@nd.edu.

First Name *

Last Name *

9-Digit University ID Number *

Email *

Grad Year *

Current Cumulative GPA *

Hometown *

Primary College/School *

Secondary College/School (if applicable)

Major 1 *

Major 2 (if applicable)

Major 3 (if applicable)

Minor 1 (if applicable)

Minor 2 (if applicable)

Minor 3 (if applicable)

Scholars/Honors Group Membership (if applicable)

Check all that apply. Complete the "Other" line if you are a member of a scholars/honors program not listed here.

AnBryce Scholars Program

Building Bridges

Glynn Family Honors Program

Grand Challenges Scholars Program

Kellogg Institute International Scholars Program

MSPS Scholars

Notre Dame Scholars' Program (list specific program under "Other...")

Posse Scholars

QuestBridge Scholars

Sorin Scholars

Other:

Current/Completed Study Abroad (if applicable)

Please indicate program and semester(s). Separate multiple programs with a semicolon. (Example: London, Summer 2015; Rome, Fall 2016)

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