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STUDENT APPLICATION FORM
for Spring, Summer and Autumn 2013

last modified 1-23-13

Full Legal Name:

First name (given name):  

Middle name or initial:  

Last name (family name):

Former Name (if not applicable leave blank):

Nickname (how you preferred to be called, if different than first name):


CURRENT MAILING ADDRESS:
Street & Number  
City
State
Zip/Postal
Country  

 

PERMANENT MAILING ADDRESS:
Street & Number  
City
State
Zip/Postal
Country  


Contact Phone, Area Code and Number: 

E-mail Address:  

Alternate E-mail Address (if none leave blank) 


Country of Citizenship 

Country of Residency 

If you are not a U.S. Citizen and have a visa, what kind is it? Leave blank if not applicable.

(If you are accepted to a course at FHL, we will assist you to obtain the necessary documents to enter the U.S.)

BIRTHDATE:
Required by University of Washington for registration; information will remain secure.


GENDER:
Used only to assign housing.


Are you currently a resident of Washington State?
Yes No
If "yes" list date Washington residency began:


University of Washington Student Number (if applicable):


What will be your ACADEMIC STATUS when you begin the course or apprenticeship at FHL:

Current college or university, if matriculated (EXAMPLE: Univ. of Washington) or
if not currently matriculated, list the institution last attended including the degree and date (EXAMPLE: Univ. of Washington (BS 6/02)

Field of Study or Degree with Major

In the box below, please list all colleges you have previously attended. List most recent first. Include dates and degrees, if any. Please include any courses or research apprenticeships you have previously attended at UW-Friday Harbor Laboratories including term and year. (Please be brief; do not exceed 600 characters, or approximately 75 words.)

Select 2013 Courses and Apprenticeships

Please carefully select course choices in one or all of the terms below. For each term (Spring, Summer A, Summer B, Post-Summer and Autumn) applicants may apply for one course plus an alternate but may attend only one course per term. Students may attend multiple terms.

Spring Quarter Term

First Choice
Alternate Choice

Summer A Term
First Choice
Alternate Choice 

Summer B Term
First Choice
Alternate Choice


Late Summer Term (short course)
First Choice (only)


Autumn Quarter Term
First Choice
Alternate Choice


Are you applying for financial aid?  
Yes   No
If so, please download the Financial Aid Request form and e-mail it to fhladmin@uw.edu.

Do you plan to use SCUBA?
Yes   No
Permission to dive under University auspices will be limited to students engaged in course work that requires diving.

Do you plan to rent bedding?  
Yes   No
Bedding rental includes: bed sheets, pillowcase and towel, exchanged weekly. Cost is $25 for 5 weeks, $50 for 10-11 weeks. We encourage students to bring their own bedding. A blanket and a pillow with pillowcase are provided free of charge to each student.

OPTIONAL: Please indicate your race/ethnicity. This information will not affect FHL admission decisions nor financial aid awards from state funds, but it is helpful to FHL when seeking financial aid from non-state sources.

To help us better track our advertising efforts, please specify how you first learned about these FHL course offerings:

By submitting this form, I certify that the above information is complete and accurate. I acknowledge that failure to disclose complete and accurate information may result in denial of admission or dismissal from the University. I acknowledge that physical injury and death are risks inherent in the use of these facilities, and I assume all associated risks and I agree not to claim against the University for those risks. I agree to hold the University of Washington harmless from any and all injuries, damages and liabilities that may occur in the course of my visit, except for negligent acts or omissions of the University or its employees, students or agents acting in the scope of their duties.

The University of Washington reaffirms its policy of equal opportunity in education regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam era veteran in accordance with University policy and applicable federal and state statutes and regulations.