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| NAME: |
| SOCIAL SECURITY NUMBER: |
| EXPECTED GRADUATION DATE: |
| MAJOR: |
| COLLEGE ADDRESS: |
| HOME ADDRESS: |
COLLEGE PHONE: |
COLLEGE FAX: |
CAMPUS PHONE: |
HOME PHONE: |
EMAIL ADDRESS (Home and School): |
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| With which faculty member would you like to work (See Faculty Research Interests): |
First Choice: |
Second Choice: |
Third Choice: |
Fourth Choice: |
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| PLEASE ENCLOSE THE FOLLOWING WITH YOUR APPLICATION: |
1. . |
2.A statement summarizing your background, your career goals, and the reason(s) you would like to participate in the Winter Term Fellowhship program (one page maximum). |
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| And send to one of the listed Biology Departments: |
| Dr. Peggy Richey at Centre College - (606) 238-5319/5200/5345 - richey@centre.edu |
| Dr. Amy Clore at New College - (941) 487-4543 - clore@ncf.edu |
| Dr. Marian Kaehler at Luther College - (319) 387-1117 - kaehlerm@luther.edu |
| Dr. Marta Laskowski at Oberlin College - (216) 775-6875 - Marta.Laskowski@oberlin.edu |
| Dr. Lin Aanonsen at Macalester - (651) 696-6470 - aanonsen@macalester.edu |
| Dr. Collen Jacks at Gustavus Adolphus College - (507) 933-7326 - cjacks@gustavus.edu |
| Dr. Mark Wilson at Colorado College - (719) 389-6996 - mwilson@coloradocollege.edu |