Please fill out completely; type or print.

Date_________________________________________

Mr., Ms. Name (Last, First, Middle)__________________________________________________

Social Security number ____________________________________________________________

Date of birth: (Month)_________________(Day)________________(Year)____________________

Current full mailing address:
Street or P.O. Box ___________________________________________________________
City _________________________________ State__________ Zip____________________
Country____________________________________________________________________
Telephone number (including Area Code) _________________________________________
Electronic mailing (E-MAIL) address:_____________________________________________
Cell phone ______________________________

Permanent or full mailing address:
Street or P.O. Box ___________________________________________________________
City _________________________________ State__________ Zip____________________
Country_____________________________________________________________________
Telephone number (including Area Code) _________________________________________
Electronic mailing (E-MAIL) address:_____________________________________________

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:_____________________________________________

DUKE STUDENTS

Undergraduate:_____ Trinity _____ Engineering _____ Other (specify)_________________
Graduate: GSAS _____ NSOE _____ Other (specify)_______________________________
Class (e.g., Jr., 1st yr. M.S.) at time of enrollment at Marine Lab (specify rising level) ________
Expected date of graduation: (Month)________________ (Year)______________________
Major______________________________________________________________________

NON-DUKE STUDENTS (attending summer session only) Unclassified:

Prebaccalaureate______________ Class (e.g., junior)______________________________
Postbaccalaureate_____________ Class (e.g. 1st yr. M.S.)_________________________
Major_____________________________________________________________________
Expected date of graduation: (Month)_________________ (Year)_____________________
If currently attending, list name and address of school_______________________________
Have you previously attended Duke: No _____ Yes _____ (Give dates):_________________
Have you received a degree from Duke: No _____ Yes _____ (Give dates):______________

ALL STUDENTS (Applying to courses numbered 100 or higher):

List courses currently in progress (which would not yet appear on a transcript):
__________________________________________________________________________
__________________________________________________________________________
List other colleges and/or universities attended and degree(s) received:
__________________________________________________________________________
__________________________________________________________________________

NON-DUKE APPLICANTS ARE REQUIRED TO COMPLETE AND SUBMIT THIS APPLICATION FORM AND TRANSCRIPT(S) OF ACADEMIC WORK COMPLETED TO DATE TO THE ADMISSIONS OFFICE.

DUKE STUDENTS ARE REQUIRED TO SUBMIT TRANSCRIPTS ONLY IF THEY ARE APPLYING FOR A SUMMER TUITION SCHOLARSHIP.

FIRST TERM: A maximum of one 6 graduate unit or 1 1/2 course program (6 semester hours) will be permitted first term (unless appropriate approval is obtained).

First Choice (Course #) ___________ (Course Title) _______________________________________

Alternate (Course #)_____________ (Course Title) ______________________________________

SECOND TERM: Students are encouraged (but not required) to take BIO 109/ENV 209 (Conservation Biology and Policy) plus one additional course.

BIO 109/ENVIRON 209 + First Choice:
First Choice (Course #)_______ (Course Title)______________________________________

BIO 109/ENVIRON 209 + Alternate:
Alternate (Course #)_______ (Course Title)______________________________________

One class only:
First Choice (Course #)_____ (Course Title)_______________________________________
Alternate (Course #)______ (Course Title)________________________________________

MARINE LAB SUMMER TUITION SCHOLARSHIPS are awarded to either US or non-US citizens on a competitive basis and cover full tuition for any one course in either Term I or II. In addition to this completed enrollment form and current academic transcript(s), scholarship applicants must submit a letter of recommendation from academic faculty and a brief statement of purpose, i.e., the reason for taking the particular course. All supporting scholarship credentials must be received by the Admissions Office of the Marine Laboratory no later than April 1. Everything can be sent through email to ml_admissions@nicholas.duke.edu. For additional information on summer tuition scholarships, consult the section on Financial Assistance.

GLOBAL FELLOWSHIPS IN MARINE CONSERVATION are available for BIO 109/ENV 209 plus one elective, subject to available funding.

Please complete below:

Please consider me for a summer tuition scholarship (due date is April 1): Yes _____ No _____

Please consider me for a Global Fellowship in Marine Conservation (all credentials due February 15; awarded to international students for BIO 109/ENV 209 plus one elective, subject to available funding): Yes _____
No _____