Home Address:__________________________________________________________________________

City:____________________________State:___________________________Zip:____________________

Home Phone: (______)___________________Message Phone: (______)______________________________

Email Address:_____________________________________________

Dissertation Title:____________________________________________________________________________________________________

One paragraph abstract of dissertation proposal:
 

 
Date completed qualifying examinations or other rite of passage to A.B.D. status, with signature of departmental representative:

_____________________________           _________________________________________________________
                          Date                                                            Departmental Representative Signature

CCWHP Member:          Y    (  )  or  N   (  ).
(This is for our information only; membership does NOT affect your chances of selection.)

SUBMIT COMPLETED APPLICATIONS (remember that most items must be in triplicate) to:

 Professor Gina Hames, Award Committee, Department of History, Pacific Lutheran University, Tacoma, WA 98477. Phone messages: (253)535-7595 or 7132.