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Course Application
 

A) Personal Information:

Please Select Today's Date: Month: Day: Year:

Name:
First Middle Last
Date of Birth:
Month: Day: Year: 19
Last 4 digits of U.S. Social Security Number:

Current
(eg. School) Contact Information:
Address Line 1 Phone
Address Line 2 Email
City State / Province Zip/Postal Code

Permanent (eg. Home) Contact Information (if different from above):
Address Line 1 Phone
Address Line 2 Email
City State / Province Zip/Postal Code

Emergency Contact:  
Name Phone

 

Planned Arrival Date: Month: Day: Year:
Planned Departure Date: Month: Day: Year:


Housing requests or concerns (e.g. allergies, disabilities, etc.):


Sex (for dorm assignments):
Female 
Male

 
How did you learn about Mountain Lake? Check all that apply.
Brochure, Poster or Display made available through my school.
Brochure sent directly to me.
Web site.
Current or former Mountain Lake student.
Current or former Mountain Lake faculty.
Instructor or Advisor.
On-line database or student opportunities clearing house.





B) Course Selection 2008:


Enrollment is limited to one course per Session
.


Session I:

Plant Conservation and Diversity: Bioinformatics, Systematics, and Field Techniques (BIOL 351/851, 4cr)
Field Entomology (BIOL 578, 3cr)
Biological Research (by special arrangement only; BIOL 597, 1-6cr): Select 1-6 credit hours:

Session II:

Conservation Ecology - From Genes to Ecosystems
(BIOL 460/860, 4cr)*
Ecology of Wildlife Diseases
(BIOL 461/861, 4cr)*
Biological Research (by special arrangement only; BIOL 598, 1-6cr). Select 1-6 credit hours:

Session III:
Biology of Fungi (BIOL 354/854, 4cr)
Evolution of Social Behavior (BIOL 470/870, 4cr)*
Biological Research (by special arrangement only; BIOL 599, 1-6cr). Select 1-6 credit hours:

* If course is marked with and '*' applicant must remember to indicate that they "intend to work with vertebrate animals" in the "Field Station Risk Acknowledgement Application" (Liability Waiver) form following this application.

Do you qualify for University of Virginia "in-state resident" fees?
Yes
No

If you answered "No" above, what is your state or country of residence?



Are you an undergraduate or graduate student?

Undergraduate Student
Graduate Student


Please list all colleges or universities attended, with degrees (if any) and dates:


Please submit a full copy of your college transcripts:
Send to:
Director
University of Virginia
Mountain Lake Biological Station
P.O. Box 400327
Charlottesville, VA 22904-4327
eml: mlbs@virginia.edu (scanned attachments OK)
fax: 434-982-5626

Communication:
Most correspondence with applicants will be via email.
Check here only if you require hardcopy correspondence via US Postal Service:


Credit: Courses at Mountain Lake are part of the Summer Session of the University of Virginia. Courses may be taken for graduate or undergraduate credit.

Fees and Payment:   Fees must be paid at least two weeks in advance of the course. Students pay room, board, and group insurance, in addition to tuition. No student can register without payment of all fees. Textbooks are purchased on-site when you arrive. All checks must be made out to "University of Virginia." Fees are subject to change. Credit Cards are NOT accepted.


C) MLBS Financial Aid Request (Optional):

Applications that include requests for financial aid are encouraged by March 15
.

Complete this section (C) only if you wish to be considered for some kind of financial assistance.

Tuition Scholarships
and Work-Study Scholarships are available based on your academic record and financial need. Statement of need and letter of recommendation are required.

Check which kind of aid you are applying for? You can apply for both:
Work Study Scholarship
- provides room and board only.  Duties involve daily work setting-up and cleaning-up the dining hall, cleaning the laboratory, grounds maintenance and assisting with opening and closing of the Station. Slightly early arrival and late departure may be required. Work load varies over the summer, but every effort is made to accommodate class schedules and demands.
Tuition Scholarships
- provides course tuition only. No duties are required. 

Statement of Financial Need: Please provide a brief statement of financial need as it relates to your ability to enroll in a course at MLBS (no official tax forms are required):


Letter of Recommendation: Please submit one letter of recommendation from a faculty member or similar academic instructor or advisor who knows you and your potential. Referee may send letter directly to MLBS or you may send it provided it is sealed and signed by the referee.
Send to:
Director
University of Virginia
Mountain Lake Biological Station
P.O. Box 400327
Charlottesville, VA 22904-4327

eml: mlbs@virginia.edu
fax: 434-982-5626


D) Review this Section and Continue:

  • Review your application for completeness and accuracy before submitting.
  • Make sure any required supplementary material reaches us by the deadline. Copies, faxes and scanned attachments are acceptable.
  • After clicking "Submit" below you may continue on and complete the on-line"Field Station Risk Acknowledgement Application" (Liability Waiver). This need not be done now, but it must be done before you arrive at the station. Remember to select the "animal use" option appropriate to your course, research, or activity.
  • Security Disclaimer: This is not a secure server. On-line forms, applications, communications, or file transfers via this site are not secured or encrypted. We can not be responsible for the security of information transmitted using this web site. You are advised not to include sensitive personal information (like SSN) in application forms or other material transmitted electronically to the station.
  • Click "Submit" below, and then please continue right on to the Liability Waiver section.


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mlbs.org or www.mlbs.virginia.edu - This page last updated:  Monday, 12-May-2008 12:20:41 EDT