USF Paris Program - Application Form

University of South Florida Summer Art Program in Paris, 2010

Application Form

application deadline: December 11, 2009

Name of Applicant: ______________________________________________________

(Last) (First) (Middle Initial)

Date of Application: ____/ ____/ ____

Student ID: __________________ Date of Birth: ____/ ____/ ____

Current Address: ______________________________

______________________________

Permanent Address (if different): _______________________________

_______________________________

Phone #: _____________________(home) ________________________ (work)

email address: ___________________________________ (print clearly)

School at which you are currently enrolled: __________________________________

Major/Minor: If Art or Art History, list area of concentration as well:

________________________________________________________________________

Current class standing: __ sophomore __ junior __ senior __graduate student __non degree-seeeking

___Florida resident ___non-Florida resident

List all institutions previously attended:

________________________________________________ Dates ______ to ______

Which course do you plan to take:
(Note: Students may enroll in only one Paris course + the London excursion.)

_____ Paris Avant-Garde: Then and Now, instructor: Robert Lawrence (4 art history credits or 3 art studio credits)
Please indicate whether you will be enrolling in this course for ____art history or ____art credit

_____ Monumental Paris: Sites of Invention, instructor: Anne Jeffrey (4 art history credits)

_____ Optional excursion to London, June 30th – July 6th, instructor: Wallace Wilson (1-3 credits)

List all art and art history courses, or any other courses relevant to the study of the arts, which you will have completed by the starting date of this program:

________________________________________________________________________

List previous travel experience:

________________________________________________________________________

Have you had any prior foreign language instruction? Explain briefly.

________________________________________________________________________

If accepted into this program, will you be applying for Financial Aid? _yes _no

List names and addresses of individuals who will sending letters of reference:

(1) Name ___________________________________ Title ________________________

Institution ______________________ Address ________________________________

(2) Name ___________________________________ Title _______________________

Institution ______________________ Address ________________________________

How did you hear about this program?

_______________________________________________________________________

Please write a one-page statement (100-200 words, typed or handwritten) explaining why you would like to participate in this summer’s program in Paris and what you hope to gain from this experience (use back of sheet if necessary):

________________________________________________	________________________________________________
applicant signature	date of application

Mail this form to:

Louis Marcus
School of Art and Art History, FAH 231
University of South Florida
4202 E. Fowler Avenue
Tampa, FL 33620-7350