James Martin Center for Nonproliferation Studies Middlebury Institute of International Studies at Monterey INTENSIVE COURSE ON NUCLEAR SAFEGUARDS POLICY AND SUMMER NUCLEAR SAFEGUARDS INTERNSHIP Application Form Please fill out completely and submit by email to Dr George Moore at gmoore@miis.edu by 5:00 p.m (Pacific Daylight Time) on Friday, March 6, 2020 Learn more: https://www.nonproliferation.org/education/courses/international-nuclear-safeguards/ Please check one: I am applying for the intensive course on nuclear safeguards ONLY I am applying for the intensive course on nuclear safeguards AND a nuclear safeguards internship I took the intensive course previously and am applying for a nuclear safeguards internship ONLY Nuclear Safeguards Course and Internship Application Applicant Information Please type in Word document if possible Current Contact Information Last Name First Name Gender (male, female, other) Year of Birth Current Street Address City, State, Zip Phone Number Email Address City, State, Zip U.S citizen? Yes No Green Card? Country(ies) of Citizenship other than the U.S Yes No Permanent Contact Information Permanent Street Address City, State, Zip Phone Number Permanent Email Address Nuclear Safeguards Course and Internship Application Educational Information Undergraduate College or University Degree Status? Graduated Graduate Student Upper Division Undergraduate Student Degree Program Specialization or Major fields Graduation Date GPA Graduate College or University Degree Status? Degree Program Specialization or Major fields Graduation Date GPA Your affiliation at the moment of application Job Title Organization Student University/College Other Graduated Graduate Student Nuclear Safeguards Course and Internship Application Experience Please list your training and/or experience in nonproliferation or international security Nuclear Safeguards Course and Internship Application Research Assistant: Internships: Government: Private Sector: NGO: Other: 500 Word personal statement Please attach, as a Word document, a statement which incorporates past experience in nonproliferation issues as well as both your short and long term educational and career goals, and how this internship and/or intensive course will help you reach those goals Please append the following: Transcript (official or unofficial) Nuclear Safeguards Course and Internship Application 500 Word personal statement One letter of recommendation Resumé Statement of needs for stipend support Please note that incomplete applications will NOT be considered By submitting this application, I understand that it is for consideration for admission to the summer internship program and one-week intensive course in nuclear safeguards Completion of this form does not guarantee my participation in these programs I further attest that all the statements on this application are true and correct to the best of my knowledge Name Date Submitted Please submit this document to gmoore@miis.edu Supplemental application materials may be turned in to Dr George Moore in hard copy at the CNS Main office located at 499 Van Buren Street, Monterey, CA 93940