| *Name (Last, First MI) |
| Personal Information--------------------------------------------------------------------------------------------------------------------------- | |||
| *Street Address | *City | *State | *Zip |
| Phone: day | Phone: night | *Email Address | |
| Educational Background------------------------------------------------------------------------------------------------------------------------ | |
| *Undergraduate degree(s): University | |
| *Degree | |
| *Major | |
| Minor | |
| *Date of Graduation | |
| Additional Academic Coursework----------------------------------------------------------------------------------------------------------- |
| University |
| Degree |
| Statement of Purpose--------------------------------------------------------------------------------------------------------------------------- |
| Please provide a statement of interest. In the statement discuss such things as, why you are drawn to Media Literacy, how you plan to use the program, and how it will help you in your career goals. Please attach this to the Application. |
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