Contact Joel Clark at (703) 307-9770 or jclark@capitaleducationdc.com for more details

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MAY ELECTIONS PROGRAM IN DC MAY 20-25, 2012

Personal Information

Name *

First

Last

Address *

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Email

Phone Number *

###

####

School if applicable

Major

Are you seeking to gain credit for this program from your home school?

Yes

I understand, that space is limited so to guarantee my spot I will complete the $250.00 deposit at www.Capitaleducationdc.com

Yes

Please provide any additional information about your participation in Elections 2012 in Washington, DC.

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Elections 2012 Program in Washington, DC Application Deposit for hotel included program due February 27, 2012 $250.00

Elections 2012 Residential Program Final Payment due April 1, 2012 $1,050.00

Elections 2012 Non-Residential (arrange your own housing) Program Deposit Due March 15, 2012 $50.00

Elections 2012 Non-Residential Program Final Payment Due April 20, 2012 $550.00

Internship Program Application Deposit $250.00

CAPITAL EDUCATION INTERNSHIP PROGRAM APPLICATION

Name *

First

Last

Intended Year of Graduation

Current Class Level *

Degree Program

Completed Credits

Current Cumulative GPA *

Proposed Internship Start Date

Proposed Internship End Date

DETAILS OF INTERNSHIP

Describe your internship interests and other goals for your time in Washington, DC. Please be as specific as possible.

How do your internship interests complement your academic studies? What are your learning objectives?

STUDENT INFORMATION

Student Email *

Address Line 1 *

Address Line 2

City *

State *

Country *

Zip Code *

Phone Number *

###

####

Gender

Date of Birth

YYYY

FACULTY ADVISOR

Faculty Advisor Name

Name of School *

Faculty Advisor Email

Address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

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