Download Report

WASHINGTON MAYMESTER PROGRAM AT C-SPAN
APPLICATION FORM for MAY 2015
DUE TBD
DOMESTIC TRAVEL COURSE NUMBER: COM 491 Credit: 3.0 hours (subject to change)
MAYMESTER DATES: Sunday, May 10, 2015, to Saturday, May 23, 2015 (immediately following the 2015 Spring
semester). Students are required to attend as many as three pre-class evening sessions in the Spring.
COURSE ENROLLMENT: Open to Purdue undergraduates in good standing in any college; admission by instructor
permission only. Class roster will be announced by early January 2015.
REQUIREMENTS: Timely submission of application; an applicant interview; a cumulative GPA of 2.3; good standing
(no probation) with the University. Early submissions are encouraged for fullest consideration.
INSTRUCTOR: Carolyn Curiel, Clinical Professor of Communication; Executive Director, Purdue Institute for Civic
Communication; former U.S. Ambassador, White House senior speechwriter, and veteran journalist.
CONTRIBUTING INSTRUCTOR: Brian Lamb, Founder and Executive Chairman, C-SPAN.
APPLICATION MATERIALS:
o Washington Maymester Program at C-SPAN application form
o Self-introduction letter, including statement of goals (maximum two pages, single-spaced, 12-pt Arial font.)
o
(Optional) Several merit scholarships are available. Please visit us at picc.purdue.edu for a list of available
merit aid for this class and to see if you qualify. Applicants desiring such aid must include with this
application an essay of 500 words describing why such assistance is merited.
o Transcript (unofficial copy is acceptable)
o $700.00 deposit by check (Check will be returned to students not accepted into the class; check is deposited
with the Bursar toward class fees when a student accepts the admission offer, no later than Jan. 5, 2015.)
o (Optional) Professional resume
REQUIREMENTS: Submit all application materials (in the order above) unfolded in a sealed envelope bearing your
name and the words “Maymester 2015 application” printed on the outside. All enclosed materials must include your
name (Last, First, Middle Initial), Purdue ID number, be printed single-sided, single-spaced in 12-pt Arial font with
one-inch margins. Personal information will be held in strictest confidence. DO NOT staple application materials.
Applications that are incomplete or fail to conform to requirements will not be considered.
TO APPLY: Bring completed application to Christopher Doty at the Purdue Institute for Civic Communication, Young
Hall, Room 455. Your deposit check for $700.00, made payable to “Purdue University,” is required as commitment
money toward the total practicum fee. Please paper-clip this atop the enclosed application materials. Write the
practicum’s course number, COM 49100, on the check “memo” line, along with your name. The program fee (minus
the $700.00 deposit) will be billed through the Purdue Bursar prior to departure.
PROGRAM FEE: The 2015 fee is expected to be about $3,000, pending University approval. This fee can be
substantially offset for qualifying students who compete and win merit aid with their essays, as described above. The
fee includes apartment housing, activities, admission and tour fees for selected Washington locations, course
materials, many meals and refreshments, local class-related transportation, and travel insurance. Additional
expenses that are each student’s responsibility include round-trip travel to DC, and about $300.00 for reasonable
other expenses, including incidentals, excluded meals, and discretionary activities.
CLASS ACCEPTANCE and WITHDRAWAL: Students accepting admission are responsible for all class fees, as well
as attending pre-class sessions and delivering on other action items; failure to meet requirements may result in
expulsion from the class. A student may voluntarily withdraw without penalty by submitting a letter via email and hard
copy to Ambassador Curiel (with copy to Mr. Doty) no later than February 23, 2015. Later withdrawals without an
acceptable reason (as determined by Ambassador Curiel) will not be refunded deposits and may be responsible for
additional class costs as determined by the University.
STUDENT CERTIFICATION/SIGNATURE:
I certify that the accompanying statements are true and accurate. I hereby give my approval to have the information
in my University records, including my transcript data and any information in the Dean of Students Office, made
available to the Selection Committee, scholarship committees, and to cooperating institutions.
_____________________________________________________________________________________________
Signature (please do not print)
Date
WASHINGTON MAYMESTER PROGRAM AT C-SPAN
Application
PURDUE ID:
PLEASE PRINT CLEARLY AND LEGIBLY.
QUESTIONS? Email picc@purdue.edu with subject line “2015 Washington Maymester”.
APPLICANT INFORMATION
Last Name
Date of Birth
(MM/DD/YYYY)
Campus Street
Address
M.I.
Date
Age
Gender
MALE
FEMALE
Apartment/Unit #
City
Primary phone (
First
State
)
ZIP
Purdue E-mail Address
Permanent Street
Address
Apartment/Unit #
City
State
Are you a citizen of the United States?
YES
NO
ZIP
If not, what is your country of citizenship?
Emergency Contact Name
(Please specify relationship, i.e., parent, spouse etc.)
Emergency Contact E-mail
Emergency Contact Phone
(
)
EDUCATION
Campus
College
Department
Major(s)
Anticipated Class
Standing, Fall 2015
Overall G.P.A.
Minor(s)
FRESHMAN
SOPHOMORE
JUNIOR
SENIOR
SENIOR+
Academic Adviser
Honors/Awards
Leadership
Experience(s)
PICC Activity, if any
REFERENCES
Please list two professional/academic references.
Full Name
Relationship
Company
Phone
(
)
(
)
E-mail
Full Name
Relationship
Company
Phone
E-mail
2
OTHER
:
WASHINGTON MAYMESTER PROGRAM AT C-SPAN
Application
PURDUE ID:
SCHOLARSHIP APPLICATION FORM
COURSE INFORMATION: COM 491, Credit: 3.0 hours (subject to change)
MAYMESTER DATES: Sunday, May 10, 2015, to Saturday, May 23, 2015
SCHOLARSHIP INFORMATION: Several merit scholarships are available for qualified students who participate in
the 2015 Washington Maymester Program at C-SPAN. See picc.purdue.edu for a list of available merit aid.
Scholarship offers will be made at the time class invitations are issued to applicants.
APPLICATIONS DUE: TBD.
APPLICATION MATERIALS:
€ Scholarship Application Form
€ 500-word essay describing why the award is merited and how the experience in Washington, DC, may help
the student achieve professional goals
Please submit all application materials unfolded in a single, sealed envelope with your name and the words
“Maymester 2015 application,” and include the words “Scholarship Application” on the exterior of the envelope.
Application materials must include your name (Last, First, Middle Initial), Purdue ID number, be printed single-sided,
and be single-spaced in 12-pt Arial font with one-inch margins.
TO APPLY:
Bring completed application to Christopher Doty at the Purdue Institute for Civic Communication, Young Hall, Room
455. Please note that each applicant must maintain good standing with the University — no one on academic or
disciplinary probation or in unresolved financial arrears with the Bursar is eligible for any travel program, and such
individuals cannot be considered for merit aid.
STUDENT CERTIFICATION/SIGNATURE:
I certify that the information I include with this application is true and accurate to the best of my knowledge.
_____________________________________________________________________________________________
Signature (please do not print)
Date
3