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Nuclear Safeguards Course and Internship Application

JamesMartinCenter for Nonproliferation Studies

Monterey Institute of International Studies

A Graduate School of Middlebury College

INTENSIVE COURSE ON NUCLEAR SAFEGUARDS POLICY

AND SUMMER NUCLEAR SAFEGUARDS INTERNSHIP

APPLICATION FORM

Please fill out completely and submit by email to Edith Bursac at by March 7, 2014

Please check one:

I am applying for the intensive course on nuclear safeguards ONLY

I am applying for the intensive course on nuclear safeguards AND a nuclear safeguards internship

I took the intensive course previously and am applying for a nuclear safeguards internship ONLY

Applicant Information

Current Contact Information

Student ID

Last Name

/

First Name

Current Street Address

City, State, Zip

Phone Number

Email Address

Are you a U.S. citizen  Yes  No

Permanent Contact Information

Permanent Street Address

City, State, Zip

Phone Number

Permanent Email Address

EducationalInformation

College or University
Degree Status /  Graduated  Graduate Student
 Upper Division Undergraduate Student
Degree Program
Specialization or Major fields
Graduation Date
GPA:

Courses on nonproliferation, nuclear weapons, nuclear energy, or related topics:

Course Name / Semester and Year / Grade

Experience

In addition to the courses indicated above, please list your training and/or experience in nonproliferation or international security

Research Assistant:

Internships:

Government:

Private Sector:

NGO:

Other:

500 Word personal statement: Please attach, as a Word document, a statement which incorporates past experience in nonproliferation issues as well as both your short and long term educational and career goals, and how this internshipand/or intensive course will help you reach those goals.

Please append the following:

Transcript(official or unofficial)

500 Word personal statement

Oneletter of recommendation

Resumé

Statement of needs for stipend support

Please note that incomplete applications will NOT be considered.

By submitting this application, I understand that it is for consideration for admission to the summer internship program and one-week intensive course in nuclear safeguards. Completion of this form does not guarantee my participation in these programs.I further attest that all the statements on this application are true and correct to the best of my knowledge.

Name:
Date Submitted:

Please submit this document to . Supplemental application materials may be turned into Edith Bursac in hard copy at the CNS Main officelocated at 499 Van Buren Street, Monterey, CA 93940.