Bill Gould, Research Ecologist
International Institute of Tropical Forestry
P.O. Box 25000
San Juan, PR
00928-5000

• Integrating research, education and traditional knowledge in the Alaskan Arctic Section 1: June 25 to July 21. $3100 includes 4 credits tuition, travel from Fairbanks Alaska to the field sites, and all gear except clothing, sleeping bag, and miscellaneous personal gear. EEB 4842, call # 83890.
  
  

Part II: Information About Yourself

On separate paper, briefly describe:

1. Field courses or field work you have completed or participated in.

2. Off-campus programs you have completed that may have relevance for wilderness travel, and wilderness research.

3. Any special skills you bring to the group (this may include medical skills, data gathering skills, camping skills, rafting or navigational skills).

4. Do you have any special needs (physical limitations, dietary needs, medical needs)?

5. A Brief Essay: Discuss how you would take advantage of this special opportunity. You should demonstrate how you would benefit academically and socially, and what motivates you to take on this challenge. Enthusiasm, compassion, character, and flexibility should be addressed.

6. Other materials needed: Please send a copy of your transcripts. It is optional but highly recommended that you include a letter of recommendation from an academic source.

Part III: Data Sheet

Complete and leave no blanks! Put 'none'or 'n/a' if you must.

First Name:
Last Name:

Current Address:
City:
State/Province:
ZIP/Postal Code:
Country:

Current Home Phone with Area Code:
A Second Phone Number:
Email address:

Your Birthdate (Month/Day/Year):
Social Security Number or Student Number:
Your Level (Year) at your university (e.g., junior, 4th year):

Permanent Address:
City:
State/Province:
ZIP/Postal Code:
Country:

Emergency Contact Person:
Emergency Phone Number with Area Code:
Other Emergency Phone Number:

Medical History

Height:
Weight:
Major previous illnesses:

Date of last tetanus or DPT shot:
Personal medications currently in use:

History of major medical problems in family:

Major system problems (e.g., circulatory, nervous, digestive, lymph):

Allergies:

Insurance carrier and policy #:
Your doctor's name and phone number:

Doctor's approval: As a physician for the person described above, I certify that the medical information on this page is true, to the best of my knowledge.

Signed:
Date:

Part IV: Deposit

Send a check payable to the University of Minnesota for $500. If you are not accepted it will be returned to you. If you are accepted, you will receive a letter and your deposit will be credited to the program cost. If you cancel up to two months before the program begins, all but $50 dollars will be returned to you. If you cancel after this time, you forfeit 50% of the program cost. Cancellations within one month of the program forfeit the full cost. If we find someone to replace you (we may have a waiting list), you will be refunded all but $50. After receiving your deposit, the University of Minnesota will bill for the remainder of the costs.