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UNIVERSITY OF WISCONSIN
GRADUATE SCHOOL
MADISON
(APPLICATION FOR UNIVERSITY FELLOWSHIP, SCHOLARSHIP, OR ASSISTANTSHIP)
This blank should be filled out and forwarded, together with all documents in support of the appli-
cation, by February 15 to the Chairman of the Department in which the candidate wishes to major.
In accordance With the rule of the Association of American Universities, notification of awards will be
made on or after April 1.
Date-8
1. Name (print) ---.     . \ L----------              L - -      _
(Last)               (First)               (Middle)
2. Proposed major field of graduate study        ----   .       .
3. Present address            -     ----------                         ----
4. Home address                                                      s     -
5.  Date  and  place  of  birth-                                     ----------------------
6. Single or married---XLA
7. Number of -ehildren- ordependents--
8. Height        -- .                 --- Weight
9.  Physical  disabilities,  if  any---          -- --- -- --- -- --- -- --- -- --- --
10. A recent, signed, unmounted photograph of passport size should be attached to this application.