Application for May Term in Mexico

Faith Seeking Justice

The Power of the Poor in the Voices of Women

May 2000

Please fill out both sides of application form and return to Jane Dickie, Psychology Department.

Name:

Campus phone:

Campus Address:

E-mail:

Home Address:

Home phone: ( )

Expected Graduation Date:

Majors: Minors:

Spanish proficiency: (circle one)

None 1 year 2 years fluent

Would you need campus housing during May 8-12? yes no

Parish or church address and pastors name if you know it or if you are a member.

Special health or other needs?

Need a passport? yes no

Do you want us to contact a pastor to seek financial assistance?

Do you want us to contact a parent?

Statement about why you want to take this course:

What special things do you have to offer the group?

Do you have a special interest in Mexico, women's studies, politics or religion? If so, please explain.