Name    _____________________________________________    Social Security No. _______________

Present address _______________________________________________________________________

____________________________________________________________________________________

Permanent address (if different) ____________________________________________________________

____________________________________________________________________________________

Current academic affiliation, department, status (Masters/Ph.D. program, teacher, etc.) __________________

____________________________________________________________________________________

Employment aside from study _____________________________________________________________

____________________________________________________________________________________

Educational experience, most recent first, including institution(s), department(s), date(s), and degree(s)

____________________________________________________________________________________

Thesis, if any __________________________________________________________________________


Grants, scholarships, and awards received: ___________________________________________________

____________________________________________________________________________________

Foreign languages (indicate fluency): ________________________________________________________

____________________________________________________________________________________


Publications: __________________________________________________________________________

____________________________________________________________________________________


Numismatic experience: __________________________________________________________________

_____________________________________________________________________________________

Attachments to this application must include:

1.        A brief statement describing your career goals, your current or future educational plans, and your interest in museum studies and in numismatics.

2.        Transcripts of your undergraduate and graduate work if they have not been submitted to the Society within the last year.



In addition, please list below the names of the two individuals to whom have given the enclosed evaluation forms.


Name and title ________________________________________________________________________

Department __________________________________________________________________________

Address _____________________________________________________________________________







Name and title ________________________________________________________________________

Department __________________________________________________________________________

Address _____________________________________________________________________________










Signature  _______________________________________   Date ____________________________