ROOTS, FRUITS & JAMAICAN ECOLOGIES Application (Summer

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ROOTS, FRUITS & JAMAICAN ECOLOGIES: PERMACULTURE INITIATIVES
IN THE BLUE & JOHN CROW MOUNTAINS
IU SUMMER SESSION I. 2010 COURSE APPLICATION
OVST J-497, 3-CREDITS, 6-WEEKS, CULTURE STUDIES CREDIT
MAY 11-JUNE 17, 2010 (MAY 29-JUNE 12 IN JAMAICA)
CAMPUS CONTACT INFORMATION:
Last Name
First
M.I.
Street
Address
Apartment/Unit #
City
State
ZIP
Cell Phone
IU E-mail Address
Work Phone
Home Phone
EMERGENCY CONTACT INFORMATION:
Last Name
First
M.I.
Street
Address
Apartment/Unit #
City
State
ZIP
Cell Phone
Emergency E-mail Address
Work Phone
Home Phone:
PERSONAL INFORMATION:
10 Digit
Student ID
Date of Birth
Gender
Ethnicity
Citizenship
Passport #
IU Campus
Attending
Major
Minor
Current GPA
Semesters at IU
Credit Hours
Earned
ACADEMIC INFORMATION:
College or
School
Spring 20010 Courses:
Course Instructors &
Course Titles
1)
2)
3)
4)
5)
Foreign
Language(s):
Studies:
1)
2)
3)
4)
IU FACULTY REFERENCE:
Name
Department
Email
COURSE-RELATED EXPERIENCES, INTERESTS & SKILLS:
Travel
Experiences
Academic
Interests
Cultural
Interests
Environmental
Interests
Special Skills
Briefly describe your goals for participating in this interdisciplinary service-learning course?
DISCLAIMER AND SIGNATURE:
I certify that the information provided in this application is true and complete to the best of my knowledge.
I understand that the non-refundable deposit of $500 will be due after Overseas Study provides email authorization for
course registration. The course deposit will be credited to the $2,200 (resident) and $2,400 (non-resident) course costs.
The 2010 costs includes: 3 IU credit hours, 41+ meals, 14 nights lodging, ground transportation, student travel insurance,
trail guide fees and workshop & presentation fees. I understand that I am responsible for purchasing my own round-trip
airline ticket to Jamaica from Indianapolis International to Kingston Manley International (in summer 2009 the airline
ticket cost was just over $512).
Signature
Date
REFERENCE LETTER, APPLICATION SUBMISSION & COURSE CONTACT:
PLEASE ASK AN IU FACULTY MEMBER TO WRITE A LETTER OF REFERENCE ON YOUR BEHALF. THE
COMPLETED APPLICATION FORM, REFERENCE LETTER, AND AN UNOFFICIAL COPY OF YOUR IU TRANSCRIPT
SHOULD BE EMAILED TO:
Dr. John Galuska, Director
Foster International Living-Learning Center
[email protected]
(812) 855-6215
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