Anne Frank in the World Exhibit by q4U295

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									                          Museum of History and Holocaust Education

                            2012 Summer Institute for
                         World War II and Holocaust Studies
                                            June 10-13, 2012

                            Extended Application Deadline: May 14, 2012

Name: ___________________________________________               Birth date: ____/____/________
Address: ___________________________________________________
City/State/Zip Code: ________________________________________

Telephone: ______________________________                 Cell phone: _______________________
E-Mail: ___________________________________ (print clearly)


EMERGENCY CONTACT:
Name: _______________________________________        Relationship: __________________________
Telephone (day): _______________________________          Telephone (evening): ______________


EDUCATION: Name of High School: ______________________________________________________
              2011-2012 academic year grade level:  Sophomore       Junior    GPA: _________


COMMUNITY SERVICE:
Organization                        Hours                        Work Accomplished
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
How did you learn about the 2012 Summer Institute for World War II and Holocaust Studies?
______________________________________________________________________________________

To complete your application, attach a 200 word essay describing why you should be chosen to
participate in this program and one teacher recommendation. Mail, email, or fax the 3 documents to:
                       Patricia Mosier
                       Kennesaw State University
                       1000 Chastain Road, MD 3308
                       Kennesaw, GA 30144
                       pmosier@kennesaw.edu
                       Fax: 770-420-4432

Applicant’s signature ________________________________________________ Date ___________

Parent’s signature   _________________________________________________ Date ___________

								
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