Name:

        Address:

        City, State, Zip:

        Email Address:  Phone:

        Birth date: Social Security number:

        Passport number: Passport issue date:

        Emergency contact person:

        Emergency contact phone number with area code:

        List Travel Experience:
       

        Academic/Professional Information:

        College attended:

        Highest degree completed: Major or Area:

        What familiarity do you have with African art and culture?

        What courses have you taken in these areas?

        Travel experience outside the US? Where and how long?

        Personal Statement:

        The statement should explain your interests in this program.  Please be as specific as you can about your motivation and desire to participate in the program.  In selecting qualified applicants, we will be grateful for any information that will distinguish you from other applicants.  Applications without this section will not be reviewed.  Your statement should be approximately 250 words.