| Name |
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| Email |
|
Excavation to which you are applying
(Cetamura or San Venanzo or Both) |
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Address Information |
| Current Address (Line 1) |
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| Current Address (Line 2) |
|
| Current Address (Line 3) |
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| Country of Current Address |
|
| Phone
Number of Current Address |
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|
Please enter if different from above |
| Permanent Address (Line 1) |
|
| Permanent Address (Line 2) |
|
| Permanent Address (Line 3) |
|
| Country of Permanent Address |
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| Phone
Number of Permanent Address |
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Personal Information |
| Passport Number (if known) |
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| Age |
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| Weight |
|
| Height |
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| Institutional Affiliation |
|
| Major |
|
| Please
list any courses or degrees in classical archaeology, anthropology,
or art history. |
|
| Please Provide the names, e-mail addresses, and phone numbers
of two academic references: |
| Academic Reference #1 |
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| Academic Reference #2 |
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Questions |
| Please
indicate if you have experience or skills pertinent to excavation
(photography, surveying, draftsmanship, computers). |
|
| Please
indicate if you have proficiency speaking, writing, or reading
the following languages: Italian, Latin, Etruscan. |
|
| Please
note general physical health and date of last check-up; indicate
any chronic health problems. |
|
| Please
indicate if you are a smoker or non-smoker. Please indicate
any prescription medications you take regularly.. |
|
| Please
indicate any special requirements or prohibitions in your
diet. We are unable to guarantee substitutions of food
for any special dietary problem. |
|
|
Personal statement of reason for wishing to participate. |
|
Note: It is required that persons participating in this excavation
obtain their own health and accident insurance. Florida
State University does not provide such insurance for the participants. Applicants who are accepted
for the excavations will be asked to provide a medical certificate
signed by their doctor and proof of health and accident insurance.
|
| Electronic Signature: |
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| Date: |
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