Entry Blank for High School Students (Please print, PRESS HARD, or type and print, with DARK INK.)
DATE: Saturday, April 2, 2011 TIME: Starts at 9 am through afternoon, by personal individual appointment (You will be contacted by phone during the weekdays preceding)
PLACE: John Carroll University, O’Malley Center: room OC 132, 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 _____
Student at (name of high school): _________________________________________________ Category B _____
Home Address: __________________________________________________________________________
__________________________________________________________________________________
Home phone ( ____ ) _____ - ________ Cell phone ( ____ ) _____ - ________ E-mail: ______________________
Years studying French? Elementary School __________ Middle/Junior High __________
High School?________
(Check only one-) Are you either/or: USA citizen? _____ permanent legal resident of USA? _____
If applicable, have you ever lived in a French-speaking country, or have you ever lived with a French-speaking family? If yes, for how long? Please also give the dates of stay, and/or the name of the school(s) that sponsored the programs:
______________________________________________________________________________________________________
Is one (or both) of your parents a native French speaker? Is French spoken at home?
______________________________________________________________________________________________________
(In addition to your prepared presentation (no notes permitted), the judges may ask you to talk about yourself and your interests.The information requested below will be helpful for initiating conversation topics with you:)
Your cultural, sport, hobby, literary, and any other interests?
__________________________________________________________________________________________________________
Countries you have visited? ____________________________________________________________________________________
(student’s signature): ___________________________________________
[ ] Student is presented by his/her high school [ ] student is presented by a teacher-member of the Maison Fr.
Teacher’s name: _____________________________________ Teacher’s signature: ___________________________________
Teachers office phone ( ____ ) _____- _______ Teacher’s Cell phone ( ____ ) _____- _______
Teacher’s E-mail: __________________
Forms may be duplicated. Information is also available on the current Maison 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 |
