| ENVIRONMENTAL STUDIES UNDERGRADUATE PROGRAM APPLICATION |
|||
| Name | ________________________ | _____________ | ___ |
(last) |
(first) | (middle initial.) | |
| ID# | ________________________ | Classification | ________________________ |
| (year in school) | |||
| Current | _________________________________________________________________________ | ||
| (local) | (street address) |
(appt#) | (city) |
| _________________________________________________________________________ | |||
(state) |
(zip) | (phone) | |
| Permanent | _________________________________________________________________________ | ||
| (home) | (street address) |
(appt#) | (city) |
| _________________________________________________________________________ | |||
(state) |
(zip) | (phone) | |
| Major | _________________________________________________________________________ | ||
Department |
______________________ | Advisor |
________________________ |
| Sex | ___Male ___Female | ||
| Herritage Code | (please check one) | ||
___ |
American Indian/Alaskan Native | ___ |
Asian American/Pacific Islander |
___ |
African American | ___ |
Hispanic |
___ |
White/nonHispanic | ___ |
International |
| Core Courses | (9 hours) | Grade | Semester Taken |
1. |
PLB301I-3 | _________ | ________________________ |
2. |
_____________ | _________ | ________________________ |
3. |
Agri/LAC 300I-3 | _________ | ________________________ |
| Electives | (6 hours) | ||
| ________________________ | _________ | ________________________ | |
| ________________________ | _________ | ________________________ | |
| ________________________ | _________ | ________________________ | |
| ________________________ | _________ |
||
| Student Signature | date |
||
| ________________________ | _________ |
||
| Major Advisor | date |
||
| ________________________ | _________ |
||
| Environmental Studies Coordinator | date |
||
| Department Use | Date Received: |
_________ | |
Date Entered Database : |
_________ | ||