SUMMER SCHOLAR COVER SHEET

PLEASE COMPLETE THIS COVER SHEET and submit with your letter of application.

Please type or print. 
_________________________________________________________________
Name
_________________________________________________________________
Current position
_________________________________________________________________
Department
_________________________________________________________________
Institution
_________________________________________________________________
Preferred mailing address (indicate whether home or office address)
_________________________________________________________________

_________________________________________________________________
City, State, Zip
_________________________________________________________________
Office phone                                                 Home phone                                    E-mail

Project Title________________________________________________________ 

Length of Residency:  [ ] 8-week term  [ ] Less than 8 weeks (specify)____________

References (List three names with addresses, phone numbers, and email addresses)

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Date Ph.D. was received or is expected:________ from ______________________

Will you be accompanied by your spouse/companion/family? If so, whom? 
__________________________________________________________________

Applications must be received by December 15. Please send to: 
                Summer Scholar Program 
                School for Advanced Research 
                P.O. Box 2188 
                Santa Fe, NM 87504-2188

By express:    660 Garcia Street 
                      Santa Fe, NM 87505