NAME: ____________________________________________________________

ADDRESS: ____________________________________________________________

E-MAIL: ___________________ MAJOR DISCIPLINE: ____________________

ADVISOR: __________________________________________

Language you wish to study and which level: ___________________________________

Geographic & topical specialization: _________________________________________

List Africa-focused and Africa-related courses taken as a graduate student:

_____________________________________________________________________________________

_____________________________________________________________________________________

________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Submit completed form to:

• an official transcript
• curriculum vita
• two faculty letters of recommendation
• a one page essay describing why the study of the African language listed above is essential to realizing your graduate studies or career goals

NOTE: Your graduate chair will also need to nominate you as a FLAS candidate.

Signature: ________________________ Date: ________________________