Madaba Plains Project

Fill in the application form completely and submit it online with your deposit. Do not overlook spaces or leave any blanks. It is important that we have all the information requested. Use N/A for blanks which really do not apply.

DEADLINE (WITH DEPOSIT) - 15 APRIL 2012 [Final payment due with other forms on 15 May 2012]

Information:

Last Name

First Name

Middle Name

Email Address

Home Phone #

Work Phone #

Passport:

Passport #

Date of Issue

Place of Issue

Expiration Date

Social Security #:

Social Security # (if American)

Present Address:

Street

City

State or Province

Postal Code

Address effective through... (date)

Address at end of school year:

Street

City

State or Province

Postal Code

Telephone #

More Info:

Place of birth

Date of birth

Country of Citizenship

Marital Status

Occupation or Field of Study

Length of Stay:

Full Season

1st Half of Season

2nd Half of Season

Emergency:

Emergency Contact

Emergency Contact's Address:

Street

City

State or Province

Postal Code

Telephone #

Institutions of higher education:

Name

Dates Attended

Degrees/Dates

Field of Study

Name

Dates Attended

Degrees/Dates

Field of Study

Name

Dates Attended

Degrees/Dates

Field of Study

Occupational experience:

Type of Work

Dates

Type of Work

Dates

Type of Work

Dates

Publications:

First Publication

Second Publication

Hobbies & Interests:

Enter Here...

Archaeological experience (I have worked at the following site(s):

Site

Position

Dates

Site

Position

Dates

I have taken the following archaeological and related courses:

Enter Here...

I have studied in the following areas:

Ancient Technology

Architecture

Art History

Botany

Ceramics

Geology

Physical Anthropology

Zoology

Other areas that might apply...

I have some experience in the following:

Typing

Video Production

Writing

Other areas that might apply...

Preferred area(s) of work:
(From the lists, list in order of preference your first five choices of work)

Language Skills:

English

Arabic

Personal Statement:

Enter Here...

Without duplicating material given above, state in a concise narrative fashion some things about yourself which might prove useful in our evaluation of your application. Include anything about your personal history, personality, future plans, and expectations for the summer that you consider appropriate. Why are you interested in archaeology? How will the project be strengthened by your participation? What will it miss without you?

Request for Academic Credit
I am enrolling for academic credit at:

None

La Sierra University

Canadian University College

Mount Royal College

Pacific Union College

Walla Walla University

I am registering for:

None

8 quarter credits/6 semester credits

4 quarter credits/3 semester credits

undergraduate credits

graduate credits

References (Give the names and address of two people (preferably in academics) who support your application):

Name

Phone

Address:

Street

City

State or Province

Postal Code

Name

Phone

Address:

Street

City

State or Province

Postal Code

Excavation Deposit (Send by 15 April):

$400 for full season

$300 for half season

I will send the remainder 15 MAY at the very latest.

Amount Outstanding:

Enter Amount

Make check payable to "Madaba Plains Project - LSU" and send to:

Madaba Plains Project
La Sierra University
4500 Riverwalk Parkway
Riverside, CA 92515

Phone: (951) 785-2041
FAX: (951) 785-2199
Email:

If all the information you have provided is correct to the best of your knowledge please check here

Your Initials Today's Date

Application Form 2012

Information:

Passport:

Social Security #:

Present Address:

Address at end of school year:

More Info:

Length of Stay:

Emergency:

Emergency Contact's Address:

Institutions of higher education:

Occupational experience:

Publications:

Hobbies & Interests:

Archaeological experience (I have worked at the following site(s):

I have taken the following archaeological and related courses:

I have studied in the following areas:

I have some experience in the following:

Preferred area(s) of work:(From the lists, list in order of preference your first five choices of work)

Language Skills:

Personal Statement:

Request for Academic Credit I am enrolling for academic credit at:

I am registering for:

References (Give the names and address of two people (preferably in academics) who support your application):

Address:

Address:

Excavation Deposit (Send by 15 April):

Amount Outstanding:

Make check payable to "Madaba Plains Project - LSU" and send to:

Preferred area(s) of work:
(From the lists, list in order of preference your first five choices of work)

Request for Academic Credit
I am enrolling for academic credit at: