GEOLOGY FIELD COURSE APPLICATION FORM
UNIVERSITY OF WYOMING
 DEPT.  3006
1000 E. UNIVERSITY DR.
LARAMIE, WY  82071


Name:  _________________________________________________ Phone Number:  __________________
Address:  _______________________________________________ E-mail Address:  __________________
                  _______________________________________________ Fax Number:  _____________________
                  _______________________________________________

 
College or University attending (or last attended):  _______________________________________________________

 
Geology courses completed and grade received:
_____ Physical Geology _____ Historical Geology _____ Sedimentation & Stratigraphy
_____ Structure _____ Geomorphology _____ Mineralogy
_____ Petrology _____ Paleontology _____ Other:  _________________

 
UW field camp does not discriminate on the basis of physical limitations.  Once you are accepted, we will ask for an explanation of any health risks or dietary requirements you have, or special accommodations you require.  Please be aware that some field areas are a few miles from the vehicles over rough terrain.  The camping sites are often primitive with no access to electricity. 

 
Name, email, and phone number of three people who can provide a reference for you (include work supervisors and at least one of your professors): 
1.  _______________________________________________________________________________________________
2.  _______________________________________________________________________________________________
3.  _______________________________________________________________________________________________

 
Briefly explain your particular qualifications, special interests, or other reasons for wishing to participate in the Wyoming Geology Field Course: