Siddharth Mohan, Biomedical Engineering Ph.D.

,, Fall 2015
HORACE H. RACKHAM SCHOOL OF GRADUATE STUDIES
UNIVERSITY OF MICHIGAN

Application Form - Page 1

Acknowledgement
I certify that all information in this application is true and complete, and that I am the author of
my Academic Statement of Purpose and Personal Statement. I understand that the University
     
and credentials may result in the withdrawal of my application or in the revocation of admission,

    !  !""  
University of Michigan.

Personal Information
First (Given)

Siddharth

Last (Family)

Mohan

No

If currently in the United States, Visa type:

SEVIS ID Number:

Other name that appears on prior academic records or test score

reports
Other First Name
Other Last Name

Name of the institution/organization that issued the I-20 or DS-2019

Race/Ethnicity (For U.S. Citizens and Permanent Residents only)

Please indicate whether you consider yourself to be Hispanic or Latino.
Yes, Hispanic or Latino
No, not Hispanic or Latino

Male

Birthdate (month/day/year)
Birthplace City

Jaipur

State/Province

Rajasthan

Country

Visa Information (Non-U.S. Citizens only)

U.S. Visa type you plan to use or obtain F1
Will you have dependents accompanying you to Michigan?

Middle

Gender

Parent #2 was a citizen or a permanent resident of the U.S. at the time I

was born.

07-08-1992

In addition, select one or more of the following racial categories to describe yourself:
American Indian or Alaska Native
Asian
Black or African American
 
  
White

India

Native Language

Malayalam

Previous Enrollment
If you have an 8 digit University of Michigan ID Number, Please
enter it here:
Have you ever taken a class at the University of Michigan - Ann Arbor
Campus? No
Are you applying to the Concurrent Undergraduate/Graduate Studies
(CUGS) program?
Have you ever registered for a Rackham class as a Rackham student?

U.S. Military Service

On active duty U.S. military
Veteran of U.S. armed forces
U.S. Reserves or National Guard
U.S. Military Dependent
Parents Education Information
Parent #1 highest educational level completed Graduate or professional degree
(ex.: M.A., Ph.D., M.B.A. or J.D.)

Parent #2 highest educational level completed Graduate or professional degree

(ex.: M.A., Ph.D., M.B.A. or J.D.)

Are you currently registered in a Rackham program as a Rackham

non-degree/guest student?
Are you currently registered in a Rackham Program as a Rackham
 $ !%

Intended Graduate Program

Biomedical Engineering Ph.D.

Subplan

Do you intend to complete this program?

If you have a Uniqname issued by the University of Michigan, please
enter it here:
@umich.edu

Proposed Term/Year of Enrollment

Fall 2015

Applying to more than one Rackham Program

United States Social Security Number

Are you applying to more than one Rackham program?

Source of Fee Waiver

Rackham program 2

Fee Waiver Code

Citizenship Status

Graduate Program Information

Rackham program 3

Non-U.S. Citizen

Country of Citizenship India

(Permanent Residents and Non-U.S. Citizens Only)

Applying to Dual Degree

U.S. Permanent Resident Registration Number A

Are you applying to a dual degree program with a non-Rackham school or

college? No

For U.S. Citizens and Permanent Residents only

Parent #1 was a citizen or a permanent resident of the U.S. at the time I
was born.

School or College

Online Application 2014-2015

Siddharth Mohan, Biomedical Engineering Ph.D.,, Fall 2015

HORACE H. RACKHAM SCHOOL OF GRADUATE STUDIES
UNIVERSITY OF MICHIGAN

Application Form - Page 2

CURRENT Address Information
Address Line 1 E-19, Mahawat
Address Line 2
City

Behind Rouse Avenue

New Delhi

Country

State/Province

Delhi

U.S. Zip/International Postal Code

91

or Pass/Fail

International Average

Ext.

State/Province

Major Field
Major Field
Degree/Diploma

Road,Railway Qtr
Level of Education

Behind Rouse Avenue

New Delhi

State/Province

Delhi

India

U.S. Zip/International Postal Code

to

Country

91-9717639950

PERMANENT Address Information

Address Line 1 E-19, Mahawat Khan

Country

on a scale of

Location City

Home Phone 91-11-23233130 Work Phone

City

GPA

Dates Attended






X
Current until
E-mail siddharthmohan2012@gmail.com

Address Line 2

Degree Status

Institution 3

India

Cell Phone

Degree Date

Khan Road,Railway Qtr

91

Degree Date

Degree Status

GPA

on a scale of

or Pass/Fail

International Average

Institution 4
Phone
Michigan Residency
Residency
Michigan Resident, since
X Non-Michigan Resident

Dates Attended

Education Information

Country

to

Location City

000000628
Birla Institute of Technology and Science Pilani
07-2014
Dates Attended 08-2010
to

State/Province

Bachelor Degree Institution

Location City
Country

Pilani

State/Province

RJ

India

Major Field
Major Field

Bachelor of Engineering

Level of Education
Degree Date

Major Field
Degree/Diploma
Level of Education

Mech Engin - Other

Degree/Diploma

Major Field

Bachelor's

07-2014

Degree Date

Degree Status

GPA

on a scale of

or Pass/Fail

International Average

Institution 5

Degree Status

Completed
Dates Attended

GPA

on a scale of

or Pass/Fail

International Average

9.04/10

Location City

to
State/Province

Country
Institution 2
Major Field
Dates Attended
Location City

to

Major Field
State/Province

Degree/Diploma

Country

Level of Education

Major Field

Degree Date

Degree Status

Major Field

GPA

on a scale of

Degree/Diploma

or Pass/Fail

International Average

Level of Education

Online Application 2014-2015

Siddharth Mohan, Biomedical Engineering Ph.D.,, Fall 2015

Application Form - Page 3

HORACE H. RACKHAM SCHOOL OF GRADUATE STUDIES

UNIVERSITY OF MICHIGAN

For U.S. Citizens and Permanent Residents only

Additional College or University Information
Indicate whether you received or will receive a degree from any of the
following institutions in the U.S.: (select all that apply)

Language 5
Native speaker?

Community or Junior College

Historically Black College or University
Predominantly Latino or Latina-Serving College or University
Single-Gender College
Tribal School or College
None of the above

Able to translate?

 
     
Speaking

Writing

Years of study in high school

Terms of study in college


  

Language 1

Additional experience

English

Native speaker?

Yes

Able to translate?

Yes

 
     
High
High
Speaking

High

Years of study in high school

Terms of study in college

Writing

High

throughout

Language 6
Native speaker?

Able to translate?

 
     
Speaking

English

Writing

Years of study in high school

Additional experience
Terms of study in college
Language 2

Additional experience

Native speaker?

Able to translate?

 
     
Speaking

Writing

Years of study in high school

Awards/ Scholarships Information

Awards/ Scholarships 1
Institution

Terms of study in college

Awards/ Scholarships 2

Language 3

Institution

Native speaker?

Open Competition

Dates or Academic Year

Additional experience

Able to translate?

DAAD WISE Scholarship

05-2013

Vamsikrishna Pendyala Memorial

BITS-Pilani

Dates or Academic Year

05-2012

 
     
Speaking

Writing

Activities Information
Since graduating from high school, have you pursued any volunteer activities, work experiences, or leadership of student organizations that were

   
based on race, ethnicity or gender, or to improving race relations in the
U.S.?
X


!"##$%

Years of study in high school

Terms of study in college
Additional experience

Language 4
Native speaker?

Able to translate?

 
     
Speaking

Writing

Years of study in high school

Terms of study in college
Additional experience

Online Application 2014-2015

Siddharth Mohan, Biomedical Engineering Ph.D.,, Fall 2015

Application Form - Page 4

HORACE H. RACKHAM SCHOOL OF GRADUATE STUDIES

UNIVERSITY OF MICHIGAN

For U.S. Citizens and Permanent Residents only:

If you attended a U.S. college or university, indicate whether you have
participated in any of the following programs that encourage students to
pursue graduate education: (select all that apply)
Bridges to the Baccalaureate
Committee on Institutional Cooperation: Summer Research
Opportunity Program (CIC SROP)
Gates Millennium Scholars Program
Graduate Engineering and Science Fellowships for Minorities (GEM)
Institute for Recruitment of Teachers (IRT)
Louis Stokes Alliance for Minority Participation (LSAMP)
Mellon Mays Undergraduate Fellowship
Minority Access to Research Careers (MARC)
Post-baccalaureate Research Education Program (PREP)
Project 1000
Ralph Bunche Summer Institute
 
     

Ronald E. McNair Post-Baccalaureate Achievement Program
Public Policy and International Affairs Program (PPIA)
Western/National Name Exchange (NNE)
None of the above

Financial Assistance Information

1. During your undergraduate study, did you receive a Pell Grant from
the U.S. Government? (For U.S. Citizens and Permanent Residents
only)
Yes
No

2. While you were an undergraduate student, did you work to pay at least
some of the cost of your undergraduate tuition, books and housing?
(Do not include work you did to pay for other expenses such as meals,
transportation or entertainment.)
Yes X No

   ! 

for the total cost of your undergraduate education (tuition, housing,
books)?

1 = little/none
"!#$  %&&  

Employment/Work Experience Information

Name of Employer 1
Position/Title
City

Research Intern

Dresden

Country

Name of Employer 2
Position/Title

Dates: from

to

07-2013

Research Intern
State/Province

TX, Texas

Other Information
If you are applying to other graduate institutions at this time, please indicate which one(s) here

Stanford
Caltech

United States

Cornell

Current Employee

Name of Employer 3
Position/Title

Dates: from

01-2014

to

07-2014

Supreet Singh Bahga,IIT Delhi

Research Intern

New Delhi

Country

05-2013

Siva Vanapalli, Texas Tech Uni

Lubbock

Country

City

State/Province

Germany

Current Employee

City

Andreas Richter,TU Dresden

State/Province

Delhi

India

Optional
I give permission to the following person to contact the graduate program
on my behalf during the application process: (optional)
First Name, Last Name

X Current Employee Dates: from 10-2014 to 06-2015

Relationship

Name of Employer 4
Position/Title
City

State/Province

Country
Current Employee

Dates: from

to

Online Application 2014-2015

Smita Paul

father's sister

Siddharth Mohan, Biomedical Engineering Ph.D.,, Fall 2015

HORACE H. RACKHAM SCHOOL OF GRADUATE STUDIES
UNIVERSITY OF MICHIGAN


 
Recommendations

Country India

Recommender 1
First Name Siva

Vanapalli

Last Name

Associate Professor

Title

Phone

+91-1596-515664

E-Mail

dbhunia@pilani.bits-pilani.ac.in

Do you waive the right to view the recommendation?

Institution/Company
Address, line 1

Texas Tech Univesity

Dept of Chemical Engineering ,TTU,Lubbock-79409-3121

Use online recommendation system?

Yes

Recommender 4
First Name

Address, line 2

Lubbock

City

TX

State

Country

Postal Code

Last Name

79409

Title

United States

Institution/Company

Phone

001-806-7421757

E-Mail

siva.vanapalli@ttu.edu

Address, line 1
Address, line 2

Do you waive the right to view the recommendation?

Use online recommendation system?

Yes
City

Yes

State

Postal Code

Country

Recommender 2
First Name Niti Nipun

Phone

Sharma

Last Name

E-Mail

Professor

Title

Do you waive the right to view the recommendation?

Institution/Company

BITS Pilani,India

Address, line 1 Mechanical Engineering Dept,BITS Pilani,Pilani

Address, line 2

Rajasthan,India -333031
Additional Information

Pilani

City

Rajasthan

State

Country

Use online recommendation system?

Postal Code

333031

India

Phone

+91-1596-245073

E-Mail

nitinipun@gmail.com

Do you waive the right to view the recommendation?

Use online recommendation system?

Yes

Yes

Recommender 3
First Name Dipendu
Last Name

Bhunia

Assistant Professor

Title

Institution/Company

BITS Pilani,India

Address, line 1

Civil Engineering Dept,BITS Pilani,Pilani

Address, line 2

Rajasthan,India -333031

City

Pilani

State

Rajasthan

Postal Code

Online Application 2014-2015

Yes

Siddharth Mohan, Biomedical Engineering Ph.D.,, Fall 2015

Biomedical Engineering
Description of Interests Form
In addition to including the following information
in your Statement of Purpose, please complete
the following.
Research Interests
Please select and rank your top three
research interests.
 


Bio-Micro/Nanotechnology and Molecular Engineering





Tissue Engineering and Biomaterials

 


Biomechanics

  



Faculty Members
   
    faculty with
whom you are interested in working.

1. Nikolaos Chronis
2. Xudong Fan
3. Joseph Bull
4. Mark Burns
 Michael Meyer

HORACE H. RACKHAM SCHOOL OF GRADUATE STUDIES

UNIVERSITY OF MICHIGAN