BISC 308 Tropical Biology Application
(Confidential: for the instructors' eyes only)

Name

Class of

Intended Major

Email

Phone

Citizenship

Please submit a copy of your passport along with your application form!

Why are you interested in taking this course?

Relevant skills and personal concerns
Please indicate one of the options below.

Swimming can't swim OK swimmer swim like a fish
Snorkeling never have few times on vacation go every chance I get
SCUBA Diving
(not required) 		not certified certified but seldom dive experienced
Hiking couch potato enjoy a walk climbed Mount Washington
Camping never slept out-of-doors camped a few times can fry an egg on a paper plate
Heat hate it with a passion can deal with it the hotter the better
Insects hate them with a passion can deal with them and don't mind getting bitten want to be an entomologist
Living Arrangements need my own room no problem sharing a room with 5 other people the more the merrier
Bathroom Facilities need a hot shower every day fine with a cold shower and a composting toilet haven't had a shower in years
Boat Trips have never been on a small boat enjoy them and don't easily get seasick love being on boats
Small Airplanes have never been on one fine being on one love parasailing

Medical concerns
(Please be honest--your life may depend on it! There are no medical facilities on the island and the nearest hospital is several hours away.)

Are you allergic to insect stings or do you have other severe allergies? No Yes

Phobias (irrational fear of insects, snakes, spiders, sharks etc.)? No Yes
If yes, please specify:

Medication required periodically? No Yes
If yes, what are they required for, are they available in Central America, and do they require refrigeration?

Do you have any other major medical problems? No Yes
If yes, please specify:

 

Katherine Rooks krooks@wellesley.edu
Date Created January 15, 2003
Last Modified March 10, 2010
Page Expires December 31, 2008