Department of Anthropology
California State University Long Beach
1250 Bellflower Boulevard
Long Beach, CA 90840-1003
DEPARTMENTAL
ADMISSION APPLICATION
Graduate
Program in Anthropology
This application is for Fall semester, ________(year). Please indicate
emphasis (circle the appropriate item):
APPLIED (cultural) ARCHAEOLOGY LINGUISTICS
NAME: _____________________________________________________
(first) (middle) (last)
PRESENT ADDRESS:
____________________________________________________________
street city state zip code
PERMANENT ADDRESS
____________________________________________________________
street city state zip code
Email address: _____________
Telephone: ( ) _________________ Date of Birth: __________________ Social
Security No: _____________
EDUCATION:
List below, complete information concerning all colleges or universities
which you have attended.
Name and Location of Institution Dates
Attended Major
Degree
& Date Awarded/Expected
______________________________|_______to_________|___________________|________________________________|
______________________________|_______to_________|___________________|________________________________|
______________________________|_______to_________|___________________|________________________________|
SCHOLARSHIPS:
List any Scholarships, Awards or Academic Honors you have received:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
LANGUAGES:: List your FIRST language: __________. Indicate your proficiency
in other languages in which you have competence. (Rate yourself E-Excellent,
G- Good, F- Fair, P - Poor
Language Reading Writing Speaking Language Reading Writing Speaking
Language Reading Writing Speaking
EMPLOYMENT: list below information concerning employment since graduation
from high school, or within the last seven years (Use continuation sheet
if more space is required.)
Employer Nature
of Work
Inclusive Dates
_____________________________|
______________________________| __________ to ___________|
_____________________________| ______________________________| __________
to ___________|
_____________________________| ______________________________| __________
to ___________|
_____________________________| ______________________________| __________
to ___________|
_____________________________| ______________________________| __________
to ___________|
REFERENCES: List below the three faculty members or employment supervisors
who best know your accademic qualification, including performance, potential,
and motivation. Give each of them one of the enclosed Request for Confidential
Information forms which they are to return directly to the Department
of Anthropology.
Name
Position
Institution / Company
_____________________________|
______________________________| _______________________|
_____________________________| ______________________________| _______________________|
_____________________________| ______________________________| _______________________|
OTHER RELEVANT INFORMATION: Indicate any other factors which you think
might be relevant to consideration of your application (such as travel
abroad, part-time employment related to your anthropological interests,
etc.)
STATEMENT OF INTEREST AND INTENT: In the following space, provide a statement
indicating why you have chosen to pursue graduate work in your chosen
emphasis, and related plans for the future.
Do you intend to be a Full-time or Part-time Student (circle one).
Date of application ________________. Applicant's signature: __________________________.
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