Lehigh University EES Field Camp 2017 Registration

Please make sure to fill ALL fields and pull down menus before submitting the application

Name:
   First: Middle: Last:

  

University:

 

Telephone: Mobile:

 

Email address:
NOTE: YOUR EMAIL ADDRESS IS SUPER-IMPORTANT. MAKE SURE THE ADDRESS YOU PROVIDE IS CORRECT  AND WILL BE ACTIVE UNTIL 30 July, 2017

Mailing address for all information
   Addr 1:
   Addr 2:
   City:
   State:
   Zip Code:
Date of Birth:  
Demographic Information:

Gender:


Citizenship (to determine International status, only select one):


If non-U.S. Citizen
Nation of Citizenship: 
Nation of Birth:           

If U.S. Citizen or Permanent Resident
Ethnicity:


Race (use "ctrl" to select more than one):
Academic Performance and Prerequisites

What year are you in your college career? 
Is a field experience a required course in your department? 
Does your Department offer any other course to fulfill the field experience?  
Is this your last course before graduation?  
Overall GPA:     Major GPA:   
Grades (IP for in progress courses, N/A if you have not taken this course) in:

(1) Physical Geology, Ecology, or intro to Environmental Sciences:,
(2) Mineralogy, Petrology, or Earth Materials: ,
(3) Sed-Strat or equivalent ,
(4) Structural Geology ,
(5) Hydrology or Geomorphology

Departmental authorization (not required for Lehigh students)
Your adviser or Department Chair must certify that you are in good standing and ready to enroll in EES 341 for 6 credits of field camp.  Please tell us your adviser's / Dept Chair's name and his/her email address.
 
Departmental Chair or Advisor name: 

Departmental Chair or Advisor email: 
__________________________________________________________________________________________________________________________

SELECTION OF CAMP RESPONSIBILITIES

All registrants must agree to participate in all three of the following camp logistical tasks.  You MUST be part of the lead group in at least one of them.
Please rank your preference for the following four tasks, with "1" being your favorite and "3" being your least preferred.

Driving and van maintenance    

Camp Kitchen 

Camp, water, and wood 

___________________________________________________________________________________________________________________________
PERSONAL DATA FORM
NOTE: This form is the only accurate method we have to notify your next-of-kin in the event of an accident or emergency. Therefore, it is important that it be filled out accurately.
 
STUDENT NAME
COLLEGE OR UNIVERSITY
 

Person to notify in case of emergency:
NAME:
RELATIONSHIP:
Home address:
Emergency Phone Number:
   I have read all of the information on the website regarding the physical and intellectual expectations and challenges that Lehigh Field Camp presents, including significant,
                             rigorous hiking every day for which I am ready.  I affirm that enjoy the outdoors, enjoy camping, and will be prepared for changeable weather conditions. 

    I have read, understand, and will abide by the posted Lehigh Field Camp Refund Policy. I further understand that I will need to secure my acceptance by a payment of $500
                              within 10 working day of the acceptance notice and FULL payment for the camp is DUE by 01 April, 2017