Seminar Application - Fall 2017

Fall 2017 Seminars

* Indicates required fields

Please select the seminar you are applying to from the list below: *

Have you participated in this seminar before?* Yes No

Some seminars are limited in the number of students that can participate each semester. Please use the fields below to enter alternative seminars you would be willing to participate in if you are not selected for your primary choice above.

Alternate choice:
Have you participated in this seminar before? Yes No

Alternate choice:
Have you participated in this seminar before? Yes No

Personal Information

First Name:* Last Name:*

NetID:* ndID (i.e. 900123456)*:

Date of Birth (mm/dd/yyyy)*:

Email Address:*

Local Address:*

City:* State: * Zip: *

Dorm: *

Local Phone:

If you have a cell phone number, please include it here.  Numbers will only be shared with student leaders and administrators to expedite important communications about class or to contact you directly in case of emergency.
Cell Phone: *

Are you a scholarship athlete?*

Gender (Required for lodging arrangements):*

Ethnicity: 2nd Ethnicity:

[Please note: ethnicity information is collected for statistical purposes only.  It is optional and not used as a factor for acceptance.]

If you are currently studying abroad or are planning to, let us know when you will be gone:

Academic Information

Student of:*


Level:* Graduation Year:*


Second Area of Study: (optional)

Second Major: Minor:

Course Requirements

Social Concerns Seminars are credit-bearing academic courses that require reading, writing, and experiential engagement activities equivalent to the workload of other one-credit courses. Please weigh your academic and other commitments carefully before applying to a seminar, and seek the advice and approval of your primary academic advisor before applying, particularly if taking the seminar will require you to get approval for an overload in credits. The Colleges have different procedures and rules regarding overloads, and the Center for Social Concerns cannot grant approval for such. Acceptance into a Social Concerns Seminars does not mean your College will automatically grant an overload, so students must work with their advisors directly if approval is required, understanding that it may not be granted if an advisor does not feel that an overload is in the student's best interest at that time.

Click here to show that you have read and understand this advice.*

Permanent Contact Information

Permanent Address: *

City:* State: * Zip: *

Country: *

Emergency Contact Information

First Name:* Last Name:* Relationship:*

Home Phone:* Cell Phone:


City:* State:* Zip:*

Country: *

Healthcare Information

Name of Insurance company:* Member Name:*

Policy Number:* Group Number:*

If you do not have health insurance, please contact Greg White at

Family Doctor:* Phone:*

Family Dentist:* Phone:*

Medical History: Allergies, if any, including medication and foods:*

Chronic or existing diseases or medical problems (e.g. diabetes, epilepsy):*

Medicines now taking and dosage:*

Date of last Tetanus injection or booster (if known):*

Any physical restrictions:*

Permission for Treatment Waiver

* I have read, understood, and hereby agree to the above Permission for Treatment Waiver

Release of Information Waiver

* I have read, understood, and hear by agree to the above Release of Information Waiver

Miscellaneous Questions

Do you have any Residence Life or legal convictions or charges that may limit your ability to participate fully at any site? *
Note: Official background checks are required at sites that work with children and at several other sites as well.

What most influenced your decision to apply?

Have you applied for any CSC Seminars in the past? *

Have you participated in any CSC Seminars in the past? *

Will you be using this seminar as part of the Catholic Social Tradition or Poverty Studies minor? *