Field Course Application, Summer 2008
Department of Geological Sciences, University of Alabama
Please fill in all the information below. The Department must receive a $100 nonrefundable deposit before April 2, 2008 in order to insure enrollment.
Name: _____________________________________________________________
UA student number : _________________________________________________
address: _________________________________________________________
_________________________________________________________
phone number: _______________________________________________________
email address:_________________________________________________________________
age: _____ sex: _____
disabilities: __________________ allergies (natural & medical): ___________________
health insurance company: ______________________ policy number: _______________
Closest relative:
name: ______________________________________________________________
address: __________________________________________________________
__________________________________________________________
phone number: ________________________________________________________
Academic background:
university attended: ___________________________________________________
academic rank: ___________________ (junior, senior, etc...)
Check the courses that you have completed:
structural geology: _ igneous and metamorphic petrology: _ stratigraphy: _
sedimentology: _ sedimentary petrology: _
overall grade point average: _________
approximate grade average in geology: _________
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