Washington Workshops Application

High School Student Application
2009

For office use only:
Deposit paid_________
Final payment________
Medical Form________
Roommate request_____

Attach photo here

Admission Policy:
     1. Schools and teachers are encouraged to select and sponsor students for program attendance; The
          Washington Workshops Foundation also encourages qualified students, at their own direct initiative,
          to file an application for Seminar attendance.
     2. The student should possess credible academic standing, an interest in the Seminar issues, and high
          standards of personal character and integrity.
     3. This application may bear the optional endorsement of a teacher or counselor signifying the
          applicant's genuine interest in learning and serious desire to participate in the educational format of
          the Seminar.
     4. The Washington Workshops Foundation does not discriminate with regard to race, color, religion,
          sex,  national and ethnic origin for admission to our programs.

(Please type or print in black ink)

Name____________________________________________ Age____________ Sex_____________

Home Address_____________________________________ Telephone No.( )________________

City/State/Zip______________________________________ E-Mail___________________________

Birth Date___________________________________ Cell Phone ( )__________________________

Parent's Name/s_____________________________________ Office Tele. No. ( )_______________

Present Year in School-circle one: Soph Junior Senior Approx. School Grade Average _____________

School____________________________________________________________________________

School Address_____________________________________________ School Tel No: ____________

School City/State/Zip ________________________________________________________________

Local Newspaper____________________________________________________________________

Mailing Address___________________________________ City/State/Zip______________________

The National Society of The Colonial Dames of America

The Congressional Seminar

June 20-26, 2009

School Activities____________________________________________________________________

__________________________________________________________________________________

Interests___________________________________________________________________________

__________________________________________________________________________________

Name and Title of High School History or Government Teacher__________________________________

Name of the Member of Congress (U.S. House of Representatives) from your District__________________

Check address where you wish to receive further information: Home____________ School____________

How did you learn of the Washington Workshops Seminar? (Former participant, teacher, poster, other.)

__________________________________________________________________________________

PLEASE NOTE:

    Participants are liable for any property damage to housing facilities they may incur during residence.
     Washington Workshops reserves the right to cancel a seminar session for lack of sufficient enrollment. In such instance all amounts already paid to the Workshops, including application fees, will be refunded.
     Washington Workshops may expel any participant for serious violation of the Code of Conduct. This Code of Conduct, included in a Student Fact Sheet, will be sent to each participant prior to arrival. All expenses incurred will be borne by the participant.
     Permission for the Washington Workshops Foundation to use photographs, quotes, videotapes, or movies taken in connection with seminar participation is hereby granted.

Parent/Guardian
I (We) the undersigned represent that I (we) are the parent(s) of and hereby agree that said child/ward may participate in this Washington Workshops Seminar.

Parent/Guardian Signature_____________________________ Office Tele. No.__________________

Student
I have read this application and seminar brochure and agree to abide by the rules and regulations of The Washington Workshops while I am in attendance at said program.

Student Signature____________________________________________

Social Studies Teacher or Guidance Counselor
In signing this application, the teacher or guidance counselor is asked to consider the applicant as a person of good character and sufficient maturity and ability to participate in the Washington Workshops study program.

Social Studies Teacher/Guidance Counselor Signature____________________________________

Please mail completed application to: