Name __________________________________ Graduation (mo/yr) __________

Local address _________________________ Local phone _________________

School ________________________________ E-mail  _____________________

Major(s) ______________________________ Advisor(s) __________________

Number of Political Science colloquia already taken _________________

If planning to study abroad, indicate semester(s) ___________________

List all courses taken in Political Science:          Grade received:

1. __________________________________________________ _______________

2. __________________________________________________ _______________

3. __________________________________________________ _______________

4. __________________________________________________ _______________

5. __________________________________________________ _______________

6. __________________________________________________ _______________

II. COLLOQUIUM REQUESTS

Semester and year applying for _____________________________________

List the Political Science colloquia you are applying for this term 
in order of preference (course number and title).  NOTA BENE: on the 
back of this page, list for each choice (1) what courses you have
taken in other departments that are relevant to this colloquium and
(2) why you want to take this particular colloquium.

Choice #1 ___________________________________________________________

Choice #2 ___________________________________________________________

Choice #3 ___________________________________________________________

To the degree possible, the Department will try to honor one of your
first two choices.  If you list fewer than three choices, you will be
assigned to a colloquium at random.  Thanks.