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Crossing Borders/Breaking Boundaries
Application Form

Deadline: April 24, 2006

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

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. Teams must submit all application materials by mail in a single envelope.

Name:______________________________ Social Security Number:________________________

Home Address:_________________________________________________________________

____________________________________________________________________________

Home Phone:_________________________ E-mail:___________________________________

Emergency Contact:_________________________________ Phone:_______________________

School Name:__________________________________________________________________

School Address:________________________________________________________________

_________________________________________ County:____________________________

School Phone:__________________________ School Fax:_______________________________

Your discipline:________________________________________________________________

Currently teaching grade(s):_____________________ Years in teaching profession:______________

How did you hear about Crossing Borders?_____________________________________________

 

I understand that I must reside on campus July 17-20.

 

__________
 (Initial)

I understand that I must attend all scheduled activities, including weekend and follow-up events.

 

__________
(Initial)

I would like to secure housing for July 21-24.

 

__________
(Initial)

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 might an exploration of the arts of the West African civilizations make its way 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

www.crbs.umd.edu/crossingborders


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 have special needs due to dietary restrictions, mobility impairment, or any other disability.