Title:
Mr.
Ms.
Mrs.
First Name
Last Name
Name of School
Currently Attending
Date of birth
(mm/dd/yy)
Country of Citizenship
Email Address
Address to which all correspondence
(including admission decision) should be sent:
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Country
Telephone Number
Permanent Address:
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Country
Telephone Number
Under Title VI of the Civil Rights
Act of 1964, we are required to ask the following question
of U.S. citizens and permanent residents. Answers will
not affect our admissions decisions. Your cooperation
is requested and appreciated.
How do you describe yourself? (optional)
African-American
Asian or Pacific Islander
Hispanic/Latino
White, Non-Hispanic
Native American
Hawaiian Native
Other (Please Specify)
Plan to apply for the
(select semester and year):
Fall 2009
Spring 2010
Summer 2010
List the names of all colleges
and universities you have attended or currently attend,
beginning with the most recent. (Include Institution,
Dates of Attendance, Major and/or Degree, and Date Expected/Received)
List academic and/or professional
honors, including scholarships, prizes, awards, etc.,
and dates received.
.
If you are accepted into the Semester In Washington Program, do you intend to live in the housing
accommodations provided?
Yes
No
Current Resume:
Essay: (Pick one of two options)
Please complete the following essay in 500 words or
less:
A. Why do you want to attend the Semester In Washington Journalism Program?
B. What does journalism mean to you today and what role does it play in your life?
How did you hear about the SIW
program? (please check all that apply)
Poster
Advertisement
Professor
Mailer/Flyer
C-SPAN
SIW Representative
SIW Alum/Friend
(Please Enter Name of Contact)
SIW Website
Walk-In
Other (Please Specify)
Comments/Questions?