Print out each page of application, fill out & fax to (202)496-9177

1.   PERSONAL INFORMATION

NAME____________________________________________________________________________________________________
                                      First                                                   Middle                                                          Last                      
 
CURRENT ADDRESS________________________________________________________________________________________
 (No P.O. Boxes)                             Street                                             City                                              State                       Zip
 
PERMANENT ADDRESS______________________________________________________________________________________
 (No P.O. Boxes)                             Street                                             City                                              State                       Zip
 
DATE OF BIRTH_________________________                U.S. CITIZENSHIP __YES __NO            __MALE __FEMALE

HOME TELEPHONE(___)______________     PERMANENT RESIDENT ALIEN REGISTRATION#_______________________________

WORK TELEPHONE(___)______________     VISA TYPE:___________________________________________________________

PERMANENT TELEPHONE(___)____________     SOCIAL SECURITY NUMBER___________________________________________
 
E-MAIL: _______________________________      DRIVERS LICENCE-#/STATE/EXPIRATION DATE:__________________________

EMERGENCY CONTACT:
  
NAME___________________________________________________        RELATIONSHIP_________________________________
 
ADDRESS_________________________________________________________________________________________________
                                            Street                                      City                                          State                       Zip
  
TELEPHONE (HOME)(_ __)____________________     TELEPHONE (WORK)(_ __)_____________________

_________________________________________________________________________________________________________
2.a. EDUCATIONAL BACKGROUND Please list most recent first:

NAME OF COLLEGE:           ____________________________________________________________________________________

LOCATION - CITY/STATE:   ____________________________________________________________________________________

DATES ATTENDED:             ___________________________

MAJOR/MINOR                     _____________________________________________

GPA:                                    _______________________GRADUATION DATE____________________________________________

NAME OF COLLEGE:          ___________________________________________________________________________________

LOCATION - CITY/STATE:  ___________________________________________________________________________________

DATES ATTENDED:            ___________________________

MAJOR/MINOR                   _____________________________________________
 
GPA:                                   _______________________GRADUATION DATE____________________________________________
_________________________________________________________________________________________________________
2.b. COMPUTER AND TECHNICAL SKILLS  Please list all of your computer and technical skills.
Include all software packages, programming languages, laboratory techniques, and
any other technical abilities that you have developed.  NOTE: many reviewers pay special attention to this section.  

_________________________________________________________________________________________________________
  
_________________________________________________________________________________________________________
 
_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________