Bioengineering Industrial Internship Program    University of California, San Diego
9500 Gilman Drive, 0412  u La Jolla, CA 92093-0412  u PHONE: (619)822-1010  u FAX: (619)534-5722
1)Complete the form on your screen  2)Print   3)Fax or mail to our office. Student Application: Premedical Bioengineering (By completing this form you agree to submit a 1-2 page report upon the completion of the first 10 weeks of your internship.)
Applicants Name:
Address:
City:
State:	Zip:
Telephone:
E-mail address
Check the Lower Division courses you have completed:
AMES 10 FORTRAN for Engineers	BE 100 Intro. to Bioengineering Design
BILD 1 The Cell	BILD 2 Multicellular Life
CHEM. 6A General Chemistry	CHEM. 6B General Chemistry
CHEM 6BL General Chemistry Lab	Chem 140A Organic Chemistry
Chem 140B Organic Chemistry	Math 20A Calculus for Science and Eng.
Math 20B Calculus for Science and Eng.	Math 20E Vector Calculus
Math 20F Linear Algebra	Math 21C Calculus and Analytic Geometry
Math 21D Introduction to Differential Equations	Phys. 2A Physics-Mechanics
Phys. 2B Physics-Electricity and Magnetism	Phys. 2C Physics-Fluids, Waves, Thermo, & Optics
Phys. 2BL Physics Elect/Mag Lab	Phys. 2CL Physics Fluids/Waves/Thermo/Optics Lab
Check the Upper Division Classes you have completed:
AMES 163 Linear Circuits	AMES 170 Experimental Techniques
BE 110 Continuum Mechanics	BE 172 Bioengineering Laboratory
BE 112A Biomechanics	BE 112B Biomechanics
BE 186A Principles of Biomaterials Design	BE 186B Principles of Bioinstrumentation and Design
BIBC 100 Structural Biochemistry	BICD 100 Genetics
BIPN 100 Mammalian Physiology I	BIPN 102 Mammalian Physiology II
Chem 140C Organic Chemistry	Majors Organic Chemistry Lab
List any technical electives you have completed:
Quarter(s) you would prefer to do an internship:	Fall    Winter    Spring    Summer
Year you would prefer to do an internship:
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