URBAN STUDIES COLLOQUIUM/SEMINAR APPLICATION

I. STUDENT INFORMATION

Name: _______________________________________________________________

School: _______________________________ Graduation (mo/yr) __________

Local address: ________________________ Local phone: ________________

E-mail address:  ____________________________________________________

Specialization: ___________________________ Advisor: ________________

II. COLLOQUIUM REQUEST

Semester and year applying for: _____________________________________

Course # and title: _________________________________________________

Why do you want to take this particular course?

List all relevant courses you have taken:		Year and Term

1. __________________________________________________ _______________

2. __________________________________________________ _______________

3. __________________________________________________ _______________

4. __________________________________________________ _______________

5. __________________________________________________ _______________

6. __________________________________________________ _______________