CONTACT INFORMATION

Name (first, middle initial, last )

Date of Birth (XX/XX/XXXX)

SSN# (Last 4 Digits)

Home Address

City, State, Zip

Home Telephone Number

Email Address

School or Institution Information:

Name of School or Institution

School or Institution Address

City, State, Zip

School Telephone Number

School Email Address (If different from above Email)

Standing (Sophmore, Junior, etc) *Students Only

Faculty Only:

Subjects taught in last 3 years

Subjects taught in academic year 2004-2005

Specify your Highest Degree

Specify your major while in graduate school

Name and business phone number of the person who will send a letter of support on your behalf:

Name

Business Telephone #

COURSE TITLE

The FAES does not discriminate on the basis of race, color, religion, sex, age, handicap, national or ethnic origin or veteran status, in administration of its educational policies, admissions policies, scholarship programs, and other educational programs.

APPLICATION AND SELECTION:

Applicants who are faculty members must fill out an application form and have it accopmany a c.v., a supporting letter from a supervisor, and a brief personal letter outlining the possible relevance of this program to their teaching responsibilities and future plans.

A transcript of the student-partner's academic record and a letter from a faculty member outlining the students' attributes and suitability for this program should accompany the application.

SUBMIT COMPLETED APPLICATION PACKAGES ONLY

All applications must be recieved 8 weeks prior to the start of the class. Selection will be based primarily on merit and perceived benefit to the application's institution. Demographics will also be a consideration.

Applicants will be notified of the outcome of the review of applications 6 weeks prior to the start of class.