SEAN-MICHAEL
MILES FELLOWSHIP APPLICATION
**This
application must be printed out.**
Please
type or print all answers. In addition, please attach a recent writing
sample and two letters of recommendation.
Max
Baucus
511 Hart Senate Office Building
Washington, DC 20510
Attn: Sean-Michael Miles Memorial Conservation Fellowship
Name:____________________________________________________________
Social Security
#:___________________________________________________
Temporary Address:_________________________________________________
_________________________________________________________________
Phone:____________________________________________________________
Permanent Address:_________________________________________________
_________________________________________________________________
Have you ever
been a Congressional Intern? Yes______ No______
If yes, list
offices and dates:___________________________________________
_________________________________________________________________
Have you ever
been convicted of a felony?
If so, please explain (a conviction will not necessarily disqualify
applicants):
_________________________________________________________________
Education
High
School Name:___________________________________________________
Address:___________________________________________________________
University:__________________________________________________________
Location (city,
state):__________________________________________________
Dates of Attendance:__________________________________________________
Date of Graduation:___________________________________________________
Anticipated Graduation
Date:_______________
Cumulative GPA:_____________
Outstanding Achievements:_____________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Please
answer the following questions and attach to this form: