Application Form for College Students
DATE: Friday, April 1, 2011 TIME: 2:00 pm
PLACE: John Carroll University O’Malley Center: OC 101 Campus map: http://www.jcu.edu/mapcampus.htm
Free parking, but please request a parking pass from the security guard at the gatehouse.
Student Candidate’s name: ________________________________________________________________ Category A _____
(Please print or type)
Student at (name of college or university) ___________________________________________________ Category B _____
Address at college/university: __________________________________________________________________________
(or home if commuter)
__________________________________________________________________________
Home phone ( ____ ) _____ - ________ Cell phone ( ____ ) _____ - ________
E-mail: _____________________________
Years studying French? Elementary School? __________ High School? _________
College/University? _________
(Check only one-) Are you either/or: a USA citizen? __________ a permanent legal resident of the USA? __________
If applicable, how long did you live with a French-speaking family, or in a college dormitory in the USA, where French was the principal language spoken? Please give dates and the name of the school(s)?
__________________________________________________________________________________________________________
Is one (or both) of your parents a native French speaker? Is French spoken at home?
__________________________________________________________________________________________________________
(The information requested below will be helpful during your oral interview, for initiating conversation topics about you:)
Your cultural and literary interests? _______________________________________________________________________
Countries you have visited? _____________________________________________________________________________
Your hobbies? _________________________________________________________________________________________
(student’s signature): __________________________________________________________
[ ___ ] student is presented by the college/university [ ___ ] student is presented by a member of the MF
Professor’s name: ________________________________________________________ (please print or type)
Professor’s signature: ______________________________________________________________
Prof.’s office phone ( ____ ) _____- ________ Cell phone ( ____ ) _____- ________
E-mail: ______________________________
Forms may be duplicated. Information is also available on Maison FR Concours Website: http://www.jcu.edu/language/maison/
Please return the completed form on or before Monday, March 28, 2011 via US mail, Fax, or scanned e-mail attachment to:
Dr. Martha Pereszlenyi-Pinter, Maison Française Contest Coordinator
Dept. of Classical & Modern Languages & Cultures, John Carroll University
20700 North Park Blvd., University Hts., OH 44118
Tel.: (216) 397-4723 (voice mail 24/7) FAX: 216-397-4653 E-mail mpereszlenyi@jcu.edu |
