(May also be
requested by mail from the address below)
Summer 2000 Expedition
to Altai Mountains, Mongolia
GirlsÕ Session (ages 14-17):
July 12-29. Tax Deductible Tuition- $4,000
BoysÕ Session (ages 14-17):
August 1-17; Tax Deductible Tuition- $4,000
Airfare Not included in above.
Dates may be subject to slight change.
Application and $500 deposit
are due on or before April 1, 2000
Balance of tuition ($3,500)
due on or before May 1, 2000
Deposit is non-refundable
after the student has been accepted into the program.
Mailing Address if different
Home phone (_____) ____________
e-mail address ____________________________________
Sex____ Height_____ Weight_____
Social Security Number______________________________
expires_________________ (if you do not yet have a passport, you can leave
this part blank for now. Please apply for a passport as soon as possible
at your local post office. You must have a passport to go on this trip).
Address of School______________________________________________________________
Emergency Contact (1)
Home Phone (____) _______________________
Cell Phone(____) _______________________
Work Phone(__) __________________
Emergency Contact (Please
Home Phone(__) ___________________
Cell Phone(___) _______________________________
Work Phone(__) ________________
Medical treatment will not be
equal to the norm in the US. Please be sure to list all special medical
conditions you may have.
Diet for foods_______________________________________________
Diabetes____ Epilepsy____ Asthma____ Allergies_______________________________________
Other Medical Conditions_________________________________________________________
Loss of Consciousness (explain and give date)_______________________________________________
Corrective Lenses/ Contacts__________ Date
of last physical examination_______________________
Along with this application,
please provide the following:
1. Three reference letters from adults who
have known you for at least one school year. One letter must be from a teacher.
(Family members do not apply).
2. A one-page, single spaced,
personal essay. Please supply the following information in the essay:
a) tell about yourself (how would you describe yourself, interests, what
would you like to do in the future, etc.) b) give 3 reasons why you want
to participate in this expedition c) give 3 reasons why you think you
would make a good KSEN expedition member.
3. A photo of yourself to be
put on KSENÕs website.
As a team member of the KSEN
project, you must adhere to regulations and maintain a standard of good
conduct. KSEN reserves the right to require a student to withdraw at any
time if conduct and behavior jeopardizes the welfare or fulfillment of
the objectives of the project. It is understood that the student's parent(s)
or legal guardian(s) will assume all responsibility, either financially
or otherwise, for any illness or injury which might occur during the expedition.
Emergency transport, medical or hospitalization costs resulting from illness
or accident during the expedition are the responsibility of the parent(s)
or guardian(s) of the student receiving such care. In cases where the
Project Leader, in consultation with local medical authorities, considers
it necessary, a student will be sent home or hospitalized. KSEN will make
every effort to ensure that ill or injured students receive proper medical
attention. The parent(s), legal guardian(s), and student are aware that
while taking part in this project certain exposure to risk may occur.
Exposure may include but not be limited to: accident and/or sickness without
readily available medical facilities, the forces of nature, travel on
the ground and in the air, and others. In consideration of the right for
the student to participate in this project, the parent(s) or legal guardian(s)
assumes all of the risks involved and agrees to indemnify and hold the
sponsors of the project harmless for any and all liability that may arise
in connection with participation in the activities. I have read and fully
understand and accept the conditions for participating as detailed above.
Parent or Guardian Signature___________________________________________________
Print Name of Parent or Guardian_______________________________________Date________________
Student Signature __________________________________________________________
Print Name of Student_____________________________________Date____________________
Please send application
packet and deposit of $500 made payable to KSEN to:
KSEN, Suzanne Lettrick, Center
for the Study of Eurasian Nomads, 1607 Walnut Street, Berkeley, CA 94709
Phone: (510) 549-3708 FAX:
(510) 849-3138 E-mail:firstname.lastname@example.org