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| *State/Province
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| E-mail
address
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| *Gender
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Female
Male
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*Age
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I would like to participate in the following seminar(s): |
| Seminar: |
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| *Title
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Alternate choice: |
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Instructor
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Dates
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Please answer the following 2 questions with clear, succinct one-page
essays for each.
What are your specific interests, goals and expectations for the above
seminar(s)?
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What experiences have you had that prepare you for pursuing advanced
study in the seminar topic?
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Lunches are provided during seminar week.
Do you have any special dietary requirements or food allergies we should be aware of?
I do not have any significant dietary restrictions
I am a strict vegetarian
I am a "vegetarian," but I do occasionally eat:
cheese
eggs
chicken
fish
shellfish
other animal products:
I have the following special dietary requirements/allergies:
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Are you fully able to participate in field trips, some of which may
involve hiking over rough terrain? Please indicate any concerns you
might have and how we might be able to help you. Information about field
trips for seminars is available (please inquire).
Do you have any special medical conditions we should be aware of?
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I will be submitting a letter of recommendation from:
my science teacher
my
high school principal |
Name and phone number in case of emergency:
I understand that during my stay at the Humboldt Field Research
Institute, reasonable efforts will be made to assure my comfort and
safety both at the institute and in the field. I recognize my own
responsibilities in this regard. Full details on liability are
available.
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