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Last Name : 
Today's Date :
University You Attend :
Email :
Current Address :  


First Name : 
Birthday :
Home Phone :
Cell Phone :
Permanent Address :  

Present College Rank : 
Major :
Minor :
Financial Aid :  


Parental Name : 
Parental Phone Day :



Parental Phone Evening :  

Please give a brief typewritten statement
of the reasons for your interest in the Columbus Program and indicate what aspect of the
program interests you . (max 250 words)
 


Applicants are required to obtain a letter of recommendation from a Kent State University faculty member or a professional supervisor who is familiar with the student.  The Person making the recommendation should send letter of recommendation directly to:

Columbus Program in Intergovernmental Issues Office
Vernon Sykes, Ph.D.
Director, CPII
c/o Department of Political Science
302 Bowman Hall
Kent State University
Kent, OH 44242-0001
Please indicate (below) the name, tile, address, and phone number of person sending letter of recommendation.
 
Reference's Name and Title : 
Address :  


  Phone :