SUMMER OF APPLIED GEOPHYSICAL EXPERIENCE
(SAGE)
Core Program June 16 (arrival)--July 8, 1999 (departure)
Sponsored by
The University of California
Institute of Geophysics and Planetary Physics
Los Alamos National Laboratory
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SUMMER OF APPLIED GEOPHYSICAL EXPERIENCE Sponsored by |
APPLICATION FORM
Name______________________________________ Social Security No.________________________
Male______________ Female______________ Phone(_____)________________________________
Citizenship_______________________ Passport Number_________________________(if not U.S. citizen)
Mailing Address:
____________________________________________________(university and department or firm, if appropriate)
________________________________________________________(street number)
________________________________________________________(city, street, zip)
________________________________________________________(email address)
Major Medical Insurer_________________________________________(proof required--copy of contract or ID card)
University in which enrolled or enrolling and address (if different from above):
______________________________________________________________________________
Undergrad*__________________Faculty Advisor___________________________(Name, Phone, Fax, email)
Graduate________________________________________________________________________ ___
Professional____________________________________________________________________ ____
Other___________________________________________________________________________ ___
Name address, and telephone number of spouse or relative in case of emergency:
Name___________________________________ Phone (______) ___________________________
Address__________________________________________________________________(street number)
________________________________________________________________(city, state, zip code or country)
Note: Fee for SAGE 1999 is $350, payable to SAGE 1999/Code U96E. $100 is due with Application Form.
Non-refundable after June 1 if application is withdrawn.
Application must be received by April 1, 1999. Send to:
SAGE 1999
IGPP, MS-C305
Los Alamos National Laboratory
Los Alamos, NM 87545 USA
(505) 667-0920; Fax (505) 665-3107
Include letter of interest, two references (see reference form) and complete transcripts. NOTE: Credit may be possible by prior arrangement with your university or through the Extension Program at the University of California, Riverside. Students must contact the UC directly.
*Includes US Citizens or permanent residents who graduated in Spring Term 1999. For these students, SAGE runs June 13 (arrival) to July 9 (departure).