Form Test

John Freemuth Student Congress

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Date of Birth -- / -- / ----

College or University you are attending(Required)

Academic Standing(Required)

Please list your current major(s):(Required)

Please list your current minor(s):

Cumulative GPA

Future plans/career aspirations(Required)

(250 words or less)

What do you hope to gain from your participation in this program:(Required)

(250 words or less)

How did you hear about this opportunity?

Essay(Required)

Accepted file types: pdf, doc, docx, jpg, Max. file size: 50 MB.

In an essay of less than 500 words, please describe your interest in public lands and fire management. Be sure to address what unique perspective you personally would bring to these topics and why. The essay should address the origins of your personal interest in and commitment to the well-being of public lands and the citizens who care about them.

Name of Reference

First Last

Email of Reference

Phone number of reference

Applicant Agreement(Required)

I have read and accept the Applicant Agreement

To the best of my knowledge and belief, there is no reason that would prevent me from being eligible to receive the John Freemuth Student Congress nomination. The Andrus Center for Public Policy has my permission to share my academic information and documents with governmental and university auditors for purposes of verifying my eligibility. I understand that in order to be eligible for this opportunity, I must be enrolled at the aforementioned school or university and continue to meet all guidelines. I understand that incomplete applications submitted without all required attachments and supporting information will not be forwarded to the selection committee for program consideration.I hereby affirm that the above information I have provided is true and correct to the best of my knowledge. I also consent that if chosen, my picture may be taken and used to promote the program. (Photo requirement may be waived by the selection committee for compelling circumstances.) I have read and accepted the above statement.

Signature - Type your name here(Required)

Name

Date of Signature -- / -- / ----