| 1. Mr., Ms. Name (Last, First, Middle)_______________________________________________
2. Social Security number ________________________________________________________
3. Date of birth: (Month)_________________(Day)________________(Year)_______________
4.A. Current full mailing address:
Street or P.O.
Box ________________________________________________________
City _________________________________ State_______ Zip____________________
Country ___________________________________________________
Telephone number (including Area Code) _____________________________________
Cell phone ______________________________________
Electronic mailing (E-MAIL) address:__________________________________________
4.B. Permanent or full mailing address:
Street or P.O. Box ________________________________________________________
City _________________________________ State_______ Zip____________________
Country ___________________________________________________
Telephone number (including Area Code) _____________________________________
Electronic mailing (E-MAIL) address:__________________________________________
5. Name and full mailing address or parents or guardian:
Name_______________________________________ Relationship_________________
Street or P.O. Box ________________________________________________________
City _________________________________ State_______ Zip____________________
Country ___________________________________________________
Telephone number (including Area Code) _____________________________________
Electronic mailing (E-MAIL) address:__________________________________________
6. DUKE STUDENTS (only)
A. Trinity _____ Engineering _____ Other (specify)_____________________________
B. Major_______________________________________________________________
C. Class (e.g., Jr., 1st yr. M.S.)
at time of enrollment at Marine Lab (specify rising level) _________
D. Date of Matriculation: (Month)_______________________(Year)_________________
Expected date of graduation: (Month)__________________ (Year)________________
7. NON-DUKE STUDENTS (Students from institutions
other than Duke who are attending for the semester only and who will be classified as special, nondegree students)
A. Name and address of home institution____________________________________
City___________________________________State_____Zip____________________
B. Major_________________________________________________________________
C. Class (e.g., junior, senior)
at time of enrollment at Marine Lab (specify rising level)___________
D. Date of matriculation: (Month)______________________(Year)_________________
Expected date of graduation: (Month)__________________ (Year)________________
E. (Optional) The following person has been requested to send
a letter of recommendation to the Admissions Office of the Duke University Marine Laboratory:
Name:______________________________________ Position___________________
Institution:_____________________________________________________________
F. Transcript(s) will be sent by the following institution(s):
________________________________________________________________________
________________________________________________________________________
G. List course(s) currently in progess (which would not yet
appear on a transcript):
________________________________________________________________________
________________________________________________________________________
H. Have you ever been placed on probation or suspended or
dismissed from any school?
No_____ Yes_____ (If yes, please explain below.)
I. Have you previously attended Duke: No _____ Yes _____ (Give
dates):_________
Have you received a degree from Duke: No _____ Yes _____ (Give dates):________
Email, Mail or Fax Enrollment form to:
Admissions Office
Duke University Marine Laboratory
135 Duke Marine Lab Road
Beaufort, North Carolina 28516-9721
FAX: 252-504-7648
TELEPHONE: 252-504-7502
E-MAIL: ml_admissions@nicholas.duke.edu
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