Cleveland Museum of Natural History

Please fill out this form and mail to:

Ann S. DuFresne, Kirtlandia Society Liaison
The Cleveland Museum of Natural History

1 Wade Oval Drive – University Circle
Cleveland, OH 44106

Adopt-A-Student Application Form

Please note: applicants should be in their college sophomore, junior, or senior year, or have graduated in the current calendar year. Do not submit your application earlier than January 1, 2008. Completed application and reference letters must be received no later than March 10, 2008! For Further Information: Please contact Ann S. DuFresne, Kirtlandia Society Liaison.

Name of Applicant:

E-mail Address:

Date:

Address Information

Permanent Address

Street	Apt/Suite

City	State	ZIP

Phone

Campus Address

Street	Apt/Suite

City	State	ZIP

Phone

Parent(s) or Guardian(s) Information:

Parent/Guardian Name
Street		Apt/Suite

City	State	ZIP

Phone

Educational/Career Information

High School

High School Attended

Graduation Date

College/University

College or University

Anticipated Graduation Date

Major in College

(continued)

Relevant Courses Taken (indicate year)

Career Plans

Preferred Research Areas

Preferred
Research
Areas

Preferred Research Area

Second Choice Research Area

Research Areas:

Mineralogy
Paleobotany
Field Geology/Paleontology
Vertebrate Paleontology

Botany
Entomology/Invertebrate Zoology
Vertebrate Zoology

Archaeology
Physical Anthropology
Cultural Anthropology

PLEASE NOTE: INTERNSHIPS MAY NOT BE AVAILABLE IN ALL RESEARCH AREAS

Recommendations

You will need two letters of recommendation from your professors or instructors, which must be posted by them via "regular" mail. Have letters sent to:

Ann S. DuFresne, Kirtlandia Society Liaison
The Cleveland Museum of Natural History
1 Wade Oval Drive - University Circle
Cleveland, Ohio 44106-1767

References

Reference 1

Name

Address

Phone

Reference 2

Name

Address

Phone

Statement

In a brief statement, explain your choice of preferred research areas. Mention your interests, previous work experience and other pertinent information which might support your application. How do you expect to benefit from your Adopt-A-Student experience?

It is suggested that you create this statement in a word processor, then cut and paste it into this box. If you are particularly interested in one department or project, please mention specifics here.

Please attach this statement on a separate piece of paper. If you are particularly interested in one department or project, please mention specifics here.

Brief Statement