Name ______________________________________________

Local Address  _______________________________________

                           _______________________________________

Permanent Address (if different from above)

                         ________________________________________

                        ________________________________________

Telephone (home) ________________ (work) ________________

Overall GPA ___________ GPA in Spanish courses ____________

List all Spanish courses taken at SIUE:
        Course                                    Semester/year                    Grade
 
 
 
 
 
 
 
 
 

Have you declared a major in Spanish?

Have you been accepted into the Teacher Educaiton Program at SIUE?
 

Please attach a one page typed essay, written in Spanish, in which you describe your career goals.
Submit complete form to:   Dr. Geert Pallemans
                                               Department of Foreign Languages and Literatures
                                               Peck Hall 2308  Campus Box 1432
                                               Southern Illinois University Edwardsville
                                               Edwardsville, IL 62026-1432