Full Name: _____________________________________________Date:______________________________________
First Name you would like to be called: _________________________________
Social Security Number:____________________________________
Campus Address:_____________________________________
Campus Phone: _____________________________U of D e-mail*:_____________________________
*You must check your e-mail frequently; e-mail is the primary way in which we will communicate with you.
Home Address:
Alternative Summer Address:
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_ _____________________________
________________________________________
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Valid Dates:____________________________________________ Valid
Dates:_________________________________________________
Home Phone:_______________________ Alternative Phone:____________________________________________
Summer e-mail:
Please update this information whenever there is a change or as your summer plans develop and when you know of a changed campus address for next fall.
Please attach an unofficial copy of your transcript.
You may also submit an essay of no more than one page entitled, "Why I should be chosen for the Australia Winter Session 2000 Program."
Submit your materials to Australia Program, Department of Economics, Purnell 407 with a refundable (if you are not chosen) check for $200.