(Please print and mail along with your $100 non-refundable deposit to Dr. John P. Staeck, Czech-American Archaeological Field School, College of DuPage, 425 22nd St., Glen Ellyn, IL, 60137-6599)
Please make checks payable to the College of DuPage.

APPLICATION FOR PARTICIPATION IN THE
COLLEGE OF DUPAGE'S EXPERIENTIAL ARCHAEOLOGY
CURRICULUM (CODEAC):
CZECH-AMERICAN ARCHAEOLOGICAL FIELD SCHOOL

Legal Name:_____________________________    Country of Residence:_______________
Preferred Name:__________________________    Date of Birth:______________________
Social Security Number:_______________________________
Mailing Address:_____________________________________________________________
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Telephone:___________________     Fax:__________________Email:___________________

Are you currently enrolled in an institution of higher education:  ____ YES  ____ NO
If so, please provide the name and address of that school:
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If so, please indicate your intended course of study (major(s)):__________________________
If so, please indicate your: Cumulative Grade Point Average:______ GPA within Major:______

Indicate which course you are enrolling for in addition to Anthropology 140: Field Archaeology
        ________  Anthropology 290: Field Laboratory Methods in Archaeology
        ________  History 290: From the Neolithic to the New Republic
        ________ No courses, paying administartive fee.

Are you capable of engaging in moderate to heavy physical activity, such as digging, moving buckets of approximately 25  to 40 pounds, and limited hiking?
_________ YES     _________ NO  (If no, or if you have questions, please contact Dr. Staeck)

Are there any physical conditions that you feel that the field school staff need to know about?  If so, please indicate them here.  Such things as medicinal allergies, insect allergies, and the like are all significant and should be reported.  (This item is intended for safety purposes only.  It is not intended for exclusionary purposes.)  
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Do you have dietary restrictions that we should be aware of?  If so, please list what these are. (This item is intended for planning and safety purposes only.  It is not intended for exclusionary purposes.)
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Interest Areas: Please indicate which of the following topics of study are of particular interest to you.  No promise is made of matching you with these items, however, efforts will be made to assign you tasks that further both your education and meet your specific interests when possible. (Check all that apply.)
____ Geoarchaeology _____ Ceramic Studies (pottery) _____ Economic Studies
____ Photography _____ Neolithic Era Studies _____  Material Illustration
____ Survey & Mapping _____ Bronze Era Studies _____ Geographic Information Systems
____ Faunal Studies (Bones) _____ Celtic/Iron Era Studies _____ Archaeological Conservation
____ Lithic Studies (Stones) _____ Medieval Era Studies _____ Fun and Adventure
Other:_____________________________________________________________________________

References:  Please provide the names, addresses, telephone numbers, and, if possible, email addresses of two people who are familiar with you personally and academically.
Name:
Name:
Title/Affiliation:
Title/Affiliation:
Address:
Address:
Telephone:
Telephone:
Email:
Email:


Please read the code of conduct posted elsewhere on this web page (or included as a hard copy).  If you have any questions about this code, please contact Dr. John Staeck.  By signing below you are agreeing to abide by the code of conduct outlined for this program.  Please also read, print, sign, and submit  the general CODEAC acknowledgement and ethics form and the injury waiver.

Signature:__________________________________    Date:_________________________