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: |