RELI4500/AMST 4500
RELI: Heart Mountain as Icon of American Landscape
And
AMST: American Civilization: Heart Mountain
20 July -31 July 2014
(Register with Summer Session 2014)
3 credits
University of Wyoming
PRINT CLEARLY IN INK or type.
Personal Information
First and last name
Phone number
Emergency contact phone number
If married, please give spouse’s
name in case of emergency
Date of birth
E-Mail Address:
Local Address:
Number and Street
City
State
Zip Code
Parent/Guardian/Permanent Mailing Address:
City
Parent’s telephone Number: (
State
Zip Code
Home E-Mail
)
Student ID Number_____________
Please list any American Studies, Religion, Geology, Geography, or Cultural Studies:
Note: It is very important to provide the following information
since we will be hiking at high altitudes and driving to high altitudes.
Do you have any allergies, asthma, or chronic medical conditions? ____No ____Yes
If “yes”, please provide additional information with this application. We will at times be out of cell range and would
require search and rescue in addition to ambulance should any major accident or illness strike.
Do you have any learning disabilities? ___No ____Yes
If “yes”, please provide additional information with this application. We have a rigorous pace for reading and
fieldwork for this 3 credit course.
Are you currently enjoying sufficient fitness to hike up to high altitudes for field excursions on Heart Mountain and
in the Bighorn Mountains? ____No _____Yes
If “no”, please provide additional information with this application. We will support a reasonable pace for all
fieldwork experiences, but if you cannot maintain a half hour minimum of hiking uphill with a daypack, it will impact
the other members of the course. We cannot allow anyone to be left behind to “catch up” due to the potential
dangers of backcountry travel, even though we will be taking only daily excursions.
Academic Information
Major(s):_____________________________________________
Minor: ______________________________
Undergraduate____ Graduate____ GPA in your major_____ Overall GPA_____
Year (please circle): 1st 2nd 3rd 4th other
Advisor:__________________________________________________________________________________
Anticipated date of graduation: _________________________________ Year:_________________________
Have you ever been placed on academic or disciplinary probation?____ yes ______no
If “yes,” please provide more information with this application.
Background Information
If you have traveled overseas or in the backcountry, please make a list of your trips. If you regularly backpack,
camp, or hike, simply state so. We want to take advantage of the backgrounds you bring to a field course
experience. This is not a test of your ability, but rather an opportunity to tell your instructors what skills and
experience you bring that might be relevant, including military, vocational, athletic, and cultural.
Location
Approximate dates
Activities
Expand if you would like:
This course is worth 3 credits. Yet in the field, we have both limited time and energy as we enjoy the visual and other
stimuli this amazing landscape offers. Thus we send out the readings in advance, and will test you on your
knowledge of the readings when we begin the course. Can your schedule accommodate this?
The following question is just to help you plan ahead. How do you anticipate meeting the estimated cost of this
program? If you select for room and board at Northwest College, the fee over 11 days would be $550. We have an
additional non-refundable fee of $100 due April 1 (or upon registration, if registering after April 1).* For short day
trips to Heart Mountain, the Heart Mountain Interpretive Center, and the Homesteader Museum, students will car
pool. Prof. Keller and Mary Humstone will be staying at private residences in Cody, and if you had an affordable
option in Cody, you could plan on car-pooling with them. Possible options include the KOA campground, and the
Ponderosa campground in Cody. (Please meet with Financial Aid to verify the amount of monies available to you.)
__ Personal Funds/parental support
___Scholarship
___Financial Aid
___Loans
Other:________________
I certify that the information given above is true and complete.
*I understand that the phrase non-refundable operates except in a case of a physical medical or family emergency.
I will pay $100 by April 1 to secure my position, first come, first served.
Signature of Student
Date
The University of Wyoming is an affirmative action/equal opportunity employer and institution and does not discriminate on the basis of race, sex, status in
any aspect of employment or services. The institution’s educational programs, activities and services offered to students and/or employees are administered on
a non-discriminating basis subject to the provisions of all civil rights laws and statistics.