Application Form 2010

Fill in the application form completely and submit it online with your deposit. Do not overlook spaces or leave any blanks. It is important that we have all the information requested. Use N/A for blanks which really do not apply.

DEADLINE (WITH DEPOSIT) - 15 APRIL 2010   [Final payment due with other forms on 15 May 2010]

 

Last Name:
First Name:
Middle Name:
Email:
Social Security # (if American)
Passport # Date of Issue
Place of Issue Expiration Date

Present Address:
Street:
City: State or Province: Postal Code
Above address effective through what date?

Telephone:
Home#: Work#:

Address at end of school year :
Street:
City: State or Province: Postal Code:
Telephone #

Place of birth Date of birth
Country of Citizenship
Marital Status
Length of Stay:

Person to be notified in case of emergency while you are abroad:
Person's Address:
Street:
City: State or Province: Postal Code
Telephone # Email

Occupation or field of study

Institutions of higher education:

Name: Dates Attended:
Degrees/Dates: Field of Study:
 
Name: Dates Attended:
Degrees/Dates: Field of Study:
 
Name: Dates Attended:
Degrees/Dates: Field of Study:

Occupational experience:

Type of Work: Dates:
 
Type of Work: Dates:
 
Type of Work: Dates:

Publications:

Hobbies, Interests

Archaeological experience: (I have worked at the following sites(s) --

Site: Position: Dates:
Site: Position: Dates:

I have taken the following archaeological and related courses:

I have studied in the following areas :




Other(s) that might apply

I have some experience in the following :





















Other(s) that might apply

Preferred area(s) of work: (From the lists, list in order of preference your first five choices of work)





Language Skills:

Personal Statement:
Without duplicating material given above, state in a concise narrative fashion some things about yourself which might prove useful in our evaluation of your application. Include anything about your personal history, personality, future plans, and expectations for the summer that you consider appropriate. Why are you interested in archaeology? How will the project be strengthened by your participation? What will it miss without you?

Request for Academic Credit:
I am enrolling for academic credit at:







I am registering for:






References:

Give the names and address of two people (preferably in academics) who support your application.

#1) Name: Phone:
Address:
Street: City State or Province: Postal Code
Email:

#2) Name: Phone:
Address:
Street: City State or Province: Postal Code
Email:

Excavation Deposit (Send by 15 April):




$ Amount outstanding

(Make check payable to "Madaba Plains Project - LSU" and send to:

Madaba Plains Project
La Sierra University
4500 Riverwalk Parkway
Riverside, CA 92515

Phone: (951) 785-2041
FAX: (951) 785-2199
Email:


If all the information you have provided is correct to the best of your knowledge please check here: your initials and today's date