NAME: ________________________________________________________________ Ms., Miss, Mrs., Mr. (circle one)

ACADEMIC MAJOR: _____________________________________________ GRADUATING CLASS (YR): ___________

COLLEGE ADDRESS: Box # ________ Telephone # ( )____________________ Email ___________________________

HOME ADDRESS: __________________________________________________________________________________

DATE OF BIRTH: ________________________ Student ID #:__________________________

Off-campus and non-LFC students should provide full college address:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

COURSE(S) APPLIED FOR:                                                             YEAR: SPRING _______
____________ GK CIV 202, Greece in the Bronze Age
____________ GK CIV 203, Greece and Turkey in the Classical-Roman Ages
____________ GK CIV 204, Greece and Turkey in the Byzantine-Medieval Ages
____________ Independent Study or Tutorial (describe)

COURSES WHICH FULFILL PREREQUISITE, if other than Gk Civ 201 (show term taken or to be taken)
Note: Students will still be expected to audit GkCiv 201.

1. ______________________________________________ 2. _______________________________________________

NAME OF PARENT(S) OR GUARDIAN: __________________________________________________________________

ADDRESS IF DIFFERENT FROM HOME ADDRESS ABOVE: ___________________________________________________

__________________________________________________________________________________________________

Parents' Telephone # (           )______________________ Parents' email: _____________________________________

If there is a second parent or guardian who should receive information, please provide name, address, phone, and email below:

__________________________________________________________________________________________________

__________________________________________________________________________________________________

On a separate page, submit a 250 word statement explaining the value you expect to realize from the program, how the program will contribute to your educational plans, and how your presence will enhance the group.

SIGNATURE: ________________________________________ DATE: ______________________

SIGNATURE OF PARENT/GUARDIAN: _______________________________________________
(Student applicant's signature here constitutes a claim to financial independence.)

SUBMIT TO: Chairperson, Program in Greece and Turkey,
xxxxxxxxxx Lake Forest College, 555 N. Sheridan Rd., Lake Forest, IL 60045