NEH SUMMER SEMINARS AND INSTITUTES
PARTICIPANT APPLICATION COVER SHEET

If you reproduce this page, the information must appear with the headings listed in the order printed here. Do not exceed the space allotted on this page. Incomplete or inaccurate applications may be deemed ineligible.

NAME:

HOME ADDRESS:

WORK ADDRESS:
(department,
institution,
street address,
city/state/ZIP)

E-MAIL:

INSTITUTION TYPE:         Public __________   Private __________

                                            2-year College _________ 4-year College __________ University _________

COURSES TAUGHT THIS YEAR--INDICATE U (UNDERGRADUATE) OR G (GRADUATE):

NUMBER OF STUDENTS TAUGHT THIS YEAR:

DEGREES YOUR DEPARTMENT GRANTS:

HOW MANY YEARS HAVE YOU BEEN TEACHING?

CITIZENSHIP (IF NOT U.S., SPECIFY COUNTRY, MONTH AND YEAR U.S. RESIDENCE BEGAN)

TELEPHONES, HOME AND WORK (include at least one where a message can be left and indicate which):

NAME OF DIRECTOR AND TITLE OF SEMINAR OR INSTITUTE TO WHICH YOU ARE APPLYING:

LIST DATES AND TITLES OF NEH SEMINARS AND INSTITUTES YOU HAVE PARTICIPATED IN:

HOW DID YOU LEARN ABOUT THE SEMINAR OR INSTITUTE?

NEH WEBSITE ___E-MAIL___ NEH FLYER (POSTED___OR SENT TO YOU___) OTHER (SPECIFY)__________

____________________________________________________________________________________________________________________
(printed name)                                                                                         (signature)                                                                            (date)