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Crossing Borders/Breaking Boundaries
Application Form

Deadline: April 23, 2004

There is a non-refundable application fee of $30 per applicant. Checks must be made payable to
University of Maryland. Memo section of check should say “ARTS INSTITUTE.”
If you have questions, please call the Center at 301-405-6832.

Please read the Program Information Sheet before proceeding with the application.

Please check one: ____ INDIVIDUAL application _____ TEAM application

If you are applying as a team, each member must supply a complete application
and statement of purpose. We request that teams submit all application materials
by mail in a single envelope.

Name: _______________________________________ Social Security Number: _______________________

Home Address:__________________________________________________________________________


Home phone: _________________________________ E-mail: _____________________________________

Emergency Contact: ___________________________________ Phone: ______________________________

School Address: __________________________________________________________________________

______________________________________________________ County: _________________________

School phone: _________________________________ School fax: _________________________________

Discipline: Dance ____ Music ____ Theater ____ Visual Arts ____ Other (Please specify)______________

Currently teaching grade(s): _______________ Years in teaching profession:___________

I understand that I must reside on campus July 19-22   __________
I understand that I must attend all scheduled activities, including weekend and follow-up events   __________
I would like to secure weekend housing for July 23-26 ___Yes ___ No __________

Statement of Purpose for All Applicants

All applicants must provide a two-paragraph response to the following question in order to be considered
for admission to the program. Please type or word-process your response on a separate sheet of paper.

How would a study of the impact of Islamic Culture on the arts of the Renaissance
fit into the curriculum you are currently teaching?

Send completed applications to:

Crossing Borders/Breaking Boundaries

Center for Renaissance & Baroque Studies
0139 Taliaferro Hall
University of Maryland
College Park, MD 20742

Phone: 301-405-6830
Email: crbs[at]umd.edu
Fax: 301-405-0956

Crossing Borders/Breaking Boundaries does not discriminate on the basis of race, color, sex, age, national origin, or disability in matters affecting eligibility or providing access to programs. Please inform us if you require adapted housing to accommodate any mobility impairment. Any individual requesting other accommodations, given a disability, must provide appropriate documentation for review.

We welcome your comments and suggestions
The Center for Renaissance & Baroque Studies
0139 Taliaferro Hall
The University of Maryland
College Park, Maryland 20742

Last updated June 11, 2007