DEPARTMENT OF ENGLISH HONORS PROGRAM

APPLICATION FORM

PART A -- TO BE FILLED OUT BY THE STUDENT (Please attach a copy of your reading list.)

Name (please print)            ________________________________________________

Address                             ________________________________________________

Telephone               __________________    Email ___________________________________

Student ID Number ______________            Date of (intended) graduation _________________

Brief description of how I will keep track of my reading and my responses:

I commit myself to undertake seriously the responsibilities involved in the English Department Honors Program; I realize that I may discontinue my participation at any time.

________________________________________ (signature) ________________ date

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PART B -- TO BE FILLED OUT BY SUPERVISING FACULTY MEMBER

I agree to serve as supervisor.

________________________________________ (signature) ________________ date

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PART C -- APPROVAL BY DEPARTMENT CHAIRPERSON

________________________________________ (signature) ________________ date

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