Davis Projects for Peace 2009

Davis Projects for Peace 2009 -- Biographical and Organization Information

*

1. Demographic Information:

Demographic Information: First Name:
Last Name:
Brandeis Mailbox:
Home Address:
City/Town:
State:
ZIP:
Country:
Full Email Address:
Mobile Phone:

*

2. Gender or Gender Expression:

Gender or Gender Expression: Male

Female

Transgender

Prefer not to answer

*

3. Race (US Census categories) - please select all that apply:

Race (US Census categories) - please select all that apply: American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Prefer not to answer

*

4. Major(s) - select all that apply:

	Programs
1.	Major(s) - select all that apply: 1. Programs
2. (if applicable)	2. (if applicable) Programs
3. (if applicable)	3. (if applicable) Programs

*

5. Minor(s) - select all that apply:

	Programs
1.	Minor(s) - select all that apply: 1. Programs
2. (if applicable)	2. (if applicable) Programs
3. (if applicable)	3. (if applicable) Programs

*

6. Undergraduate Graduation Date:

Undergraduate Graduation Date:

*

7. Cumulative GPA:

Cumulative GPA:

*

8. How did you learn about Davis Projects for Peace? Please check all that apply:

How did you learn about Davis Projects for Peace? Please check all that apply: Web site Email announcement Campus Newspaper(s) Flier	Faculty or Staff Other Student(s) Internship Funding Information Session
Other (please specify)

*

9. Please provide us with your organization information:

Please provide us with your organization information: Organization Name:
Supervisor Name:
Address:
City/Town:
State (if applicable)
ZIP/Postal Code:
Country:
Supervisor's Email Address:
Supervisor's Work Phone Number:

10. Organization's Web site:

Organization's Web site:

*

11. How did you hear about this organization? Please check all that apply.

How did you hear about this organization? Please check all that apply. Hiatt NACELink Hiatt-listed database of internships Alumni contact Friend or family contact My own search	Faculty or staff recommendation Student recommendation Organization's web site Campus information session Career and Internship Fair
Other - Please specify:

By submitting this online application, I agree to the following:
- Under the terms of the Family Rights and Privacy Act of 1974, applicants have the right to review recommendations. However, submitting my application indicates that I waive my right to see the recommendation.
- I authorize Brandeis University to use my application in future promotional materials or for employer contacts.

Congratulations! This is the end of the on-line application. Once you see a confirmation page, your application has been received. Please know that you will not get a confirmation email, but that the confirmation page indicates receipt of your materials. Press 'submit' to record your answers. (Please note: the rest of your application materials should be submitted as a single, hard-copy packet; see www.brandeis.edu/ethics/atbrandeis/davis for more information.)

Application