Return Completed Application
to:
K. Renee Barlow SCC N286
Salt Lake Community College
1575 South State
Salt Lake City, UT 84115
renee.barlow@slcc.edu
Date of Birth:_______________ Phone:(____)____________ Email:___________________________
Mailing Address (from now until field school):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Permanent Address (if different from above):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Person to notify in case of emergency:
Name:_______________________________ Relationship:___________ Phone:(____)____________
Address: _____________________________________________________________________________
____________________________________________________________________________________
Which sessions would you like to attend?
___June 7-16
___June 21-30
___July 5-14
Fieldwork often involves strenuous labor in remote areas where access
to medical facilities is limited. Do you have any physical handicaps,
disabilities, allergies, or other conditions or circumstances which might
interfere with your participation in the program? If yes, fully explain
below and consult your physician concerning the advisability of attending
field school.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
The following information is optional, but provides important background
information for the instructor.
Are you currently enrolled at SLCC? ________ Name/year of high school
___________________
Name of other school, college or university most recently attended. _________________________
Major area of study: ____________________________ Minor: ____________________________
High School GPA: ____________ College/University GPA: ___________
Return completed application to:
K. Renee Barlow SCC N286
Salt Lake Community College
1575 South State
Salt Lake City, UT 84115
renee.barlow@slcc.edu
 
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