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: __________________________.