Campanile & Capital

UC Berkeley Washington Program
Online Application

Note: Fields marked with an asterisk (*) are required. You may need to widen or scroll your browser window to see the entire form.

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  1. Contact and Academic Information
  2. Your Background, Interests and Skills
  3. Your Interview Availability
  4. Submitting Your Application

1. Contact and Academic Information

*Name Mr. Ms.
*First Name
*Family Name
*Local
Address

*City
*State
*Zip
*Local Phone Please format: 510-642-2000
*Email 1
Email 2
(optional)
*Student ID
*Major(s)
  *How many units will you have earned at UCB (excluding AP or transfer units) by the semester you want to go to DC?
*Permanent Address

*City
*State
*Zip
*Perm. phone Please format: 510-642-2000
Emergency Contact:
*Name
*Relationship
*Address

*City
*State
*Zip
*Phone Please format: 510-642-2000
Email

*Semester you want to be in DC: Fall 12 Spring 13 Fall 13 Spring 14
*Current class standing: Sophomore Junior Senior Graduating Sr.
*Semester/year you expect to graduate:
*Your GPA:
*Your College at UCB:
*Are you receiving financial aid now? Yes No
*Are a US Citizen? Yes No
If no, your immigration status: Perm. resident
F-1 Student
J-1 Student
H-1B Temp. work
Other
 Please note:

You do not need to be a US Citizen to participate in the UCB Washington Program.

US Citizenship is required for some internships, however.
Do you have dual citizenship? Yes No
If yes, countries:


2. Your Background, Interests and Skills

Please list the courses you are taking this semester:
*Course title
  Example: Politics and the News Media





 *Dept., Number
  Poli Sci 111A





 *Instructor
  Prof. Ted Spinmeister

*Please list your area(s) of interest, and possible topic(s) for the research project you would like to do in DC, in order of preference or priority:
 
* Interested in an internship in Congress, the Senate, or the White House? If so, please check the box and you'll receive information about the Matsui Fellowship. Yes
No
 

*Please list three specific organizations (agencies, institutes, museums, etc.) in which you might like to intern:
 
If you want to intern in an organization that requires a security clearance, have you begun the process of applying for clearance? Yes No
 
Please list upper-division courses you have taken at UC Berkeley that will prepare you for the research and internship you propose:
*Course title
  Example: Politics and the News Media




 *Dept., Number
  Poli Sci 111A




 *Instructor
  Prof. Ted Spinmeister

*Your language skills:
*Your computer skills:
Mac
PC
Excel/spreadsheet
Wordprocessing
HTML
Internet/email
Database
Other
Details/other computer skills:


3. Your Interview Availability

Some applicants will be invited to an interview as part of the selection process. Interviews last about 20 minutes and are conducted on the UCB campus by the Berkeley Program Coordinator (Kathy Slusser) and Program alumni.

Interviews of applicants for the Fall 2011 Program will be scheduled between 9 a.m. and 12 noon, then 1-5 p.m. from Monday, March 14th, through Wednesday, March 16th.

Please indicate below the days and times you would be available for an interview during that period, if requested.

Please provide at least three options. Thank you!

Choose an
interview date		 Time
available
(ex. 10am-2pm)
*First choice
*Second choice
*Third choice
Fourth choice


4. Submitting Your Application

Please check your answers to verify their correctness.

When you are finished, click the "submit" button below (ONCE only please).

After you have submitted this form:

  1. Please print two copies of your application.
  2. Keep one for your records.
  3. Sign the second copy, and turn it in to the Program Office with the following items:
    • One paper copy of your Statement of Purpose (2 double-spaced pages, 500 words);
    • One paper copy of your Resume (one page only);
    • One paper copy of your Writing Sample (no more than 5 double-spaced pages); and
    • Official transcripts from every college or university you have attended.
    • Please DO NOT staple or paper clip any application materials.
    • Please DO NOT double-side any application materials (make sure to tell your recommenders this as well).
    • Please DO remember to sign your application and recommender forms.
  4. Attach electronic copies of your Statement of Purpose, Resume, and Writing sample to an e-mail, and send to ucdc_application@learning.berkeley.edu.
  5. Complete your Recommender Forms.

The deadline for the Fall 2012 Semester is Wednesday, February 29, 2012 at 4 P.M.

     

The information I have provided on this form is complete and accurate:

______________________________
Signature:		 ______________________________
Print name:		 ___________________
Date: