AMERICAN ODYSSEY

  PARTICIPANT APPLICATION

PERMANENT ADDRESSSCHOOL ADDRESS

Name _________________________________________________

Address _______________________________Address _____________________________________________

______________________________________________________________________________________

Phone _______________________________  Phone ________________________________________________

E-Mail _______________________________  E-Mail ________________________________________________

Age ____________Birthday ____________________Shirt Size: ________________

                               

Teaching Fellow      Yes   No Freshman     Sophomore    Junior     Senior     (as of date of trip)

                           circle one)                      (circle one)

Professor that knows you well ________________________________Major ________________________

GPA ________

                   List any Honors Received

          Clubs, Extra Curricular Activities     in the last 3 years

  You Participate in at School(School or Community)

           List Qualifications you feel that

List Hobbies and Interests                you possess for this trip

How do you feel others see you?

If you are accepted, what will the other participants like most about you?

If you are accepted, what will the other participants like least about you?

Please give three reasons why YOU really want to go on this trip

Name and address of a friend who you would like to have apply for the trip:

___________________________________________________________________________________________

___________________________________________________________________________________________

On the back of this sheet you may write anything about yourself or include (attach)anything that may help the selection committee reach their decision concerning your participation.

Please include two letters of recommendation . . . One from an adult friend or professor and the other from a peer.

______________________________________________________________________________________

                       Parent Signature      Applicant Signature

             ___________________________

                                 Date                                            

Please forward this application to:

  David Barlow * American Odyssey    

                           P.O. Box 198    Landis, NC  28088

Phone: (704) 855-2511  

Email: americanodyssey@gmail.com

Please indicate which Experience this Application is being Submitted for.

__________________________