University of Wyoming

Program Application for Summer Study

 

CRMJ 4990: Urban Criminal Justice: Chicago

 

PRINT CLEARLY IN INK OR TYPE ALL INFORMATION

Turn in application before 12:00pm March 2nd, 2022

For questions, email ewodahl@uwyo.edu

Please fill out all fields. The University of Wyoming is an affirmative action/equal opportunity employer and institution and does not discriminate on the basis of race, sex, or status in any aspect of employment or services. The institution’s educational programs, activities, and services offered to students and/or employees are administered on a non-discriminating basis subject to the provisions of all civil rights laws and statistics.

Full name: *
W#: *
Date of Birth: *
Gender: *
Email Address: *
Local Address: *
Phone number: *
Parent/Guardian Name: *
Parent/Guardian Address: *
Parent/Guardian Phone Number: *
Major: *
Minor: *
Status: *
Undergraduate Graduate
College: *
Year: *
1st 2nd 3rd 4th Other
Total Earned Credit Hours: *
Advisor: *
Anticipated Graduation Date: *
Have you ever been placed on academic or disciplinary probation?: *
Yes No
If yes, please include additional information with this application:
Previous educational travel (UW sponsored): *
Have you ever been convicted of a crime (felony or misdemeanor): *
Yes No
If yes, please explain below:
Please list two UW faculty references, at least one of whom must be in the Department of Criminal Justice #1: *
Please list two UW faculty references, at least one of whom must be in the Department of Criminal Justice #2: *
How do you anticipate meeting the costs of the program? (Please meet with Financial Aid to verify the amount of monies available to you): *
Personal Funds Scholarship Parental Loans Loans Financial Aid Other (please explain below)
If "Other", please explain:
I certify that the information given above is true and complete. I understand that as a participant I shall be subject to certain rules and requirements of the University, including University Regulation 8-30 (student conduct), and cooperating agencies, which I agree to fulfill in all respects, subject to immediate dismissal if I do not do so. I agree to assume financial responsibility for the program fees and costs and for my own welfare while participating in this course.: *