Archaeology Field School 2020 Application Please fill out this application to the best of your ability. There are four sections and you will need copies/scans of your diving certifications and trainings.Please enable JavaScript in your browser to complete this form.1234Section 1: Applicant InformationFirst Name *Last Name *Preferred Name *Age *Birth Date *Address *City *State/Province *Zip Code *Primary Phone *What type of phone is this? *HomeCellOffice/WorkEmail *T-Shirt Size *Are you interested in Museum-offered housing? *YesNoDietary needs/restrictionsUniversityMajorCurrent level in schoolFreshmanSophomoreJuniorSeniorRecently graduatedMaster's programPhD programDo you want to take this program for graduate-level credit from Castleton University? *YesNoThis program is eligible for 3-4 credits from Castleton University at an additional cost. If you select yes, we will provide further information upon your acceptance into Field School.How did you hear about Field School? *NextSection 2: Emergency Contact InformationEmergency Information: In case of an emergency, whom should we contact? Emergency Contact Name *FirstLastEmergency Contact Primary Phone *What type of phone is this? *HomeCellOffice/WorkEmergency Contact Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryPreviousNextSection 3: Diving Experience ResumeDate of Last Physical *Are there any medical conditions that limit your diving? *YesNoPlease explain *Have you ever experienced a diving accident? *YesNoPlease explain *Highest Diving Certification LevelBasic Diving CertificationAdvanced DiverMaster DiverDivemasterAssistant InstructorInstructorRescueOtherOther: Agency, Type, and YearAdvanced Diver Certification Click or drag a file to this area to upload. Upload a copy/scan of this training or certificationMaster Diver Certification Click or drag a file to this area to upload. Upload a copy/scan of this training or certificationDivemaster Certification Click or drag a file to this area to upload. Upload a copy/scan of this training or certificationUpload a scan/copy of your DAN Diver Insurance Click or drag a file to this area to upload. Upload a copy/scan of this training or certificationUpload a scan/copy of your CPR and First Aid Certification Click or drag a file to this area to upload. Upload a copy/scan of this certificationDo you have Oxygen Admin certification? *YesNoUpload a copy/scan of your O2 Admin Certification Click or drag a file to this area to upload. Upload a copy/scan of this certificationCareer Open Water Dives (estimate) Number of Dives *Max Depth *Date of Last DiveDepth of Last DiveNumber of Dives in the Past YearAverage/Regular DepthIndicate your previous diving experiencesDiving from Boats/ShipsShore DivingOverhead Environment DivingFreshwater DivingNight DivingDecompression DivingDiving at SeaDiving EMT/Chamber OperatorCold Water Diving (<60 degrees) Limited Visibility Diving (less than 5' visibility)Zero Visibility DivingVery Clear Water (+50' visibility)Saltwater DivingMud or Silt Bottom DivingCoral Reef DivingStrong Current Diving (over 1/2 knot)Underwater Photography/VideoDry Suit DivingNitrox/Mixed Gas DivingCommercial DivingMilitary DivingSurface-Supplied DivingScientific or Research DivingTell us more about your diving experience and projectsNextSection 4: Lake Champlain Maritime Museum Field School AgreementPlease review EVERY statement before checking the box to indicate your agreement. If your application is accepted, upon your arrival in May, you will be asked to sign this document. 1. I have studied the course syllabus and information contained in the Field School description, and understand the policies, regulations, and expectations for this Field School. Yes2. I recognize that, if applicable, I am responsible for completing all academic requirements to receive credit, and that I must arrange any transfers of credit to my home institution. Yes3. I have completed a physical examination with my physician within the past year (2019-20) and I will complete and return a signed medical waiver form upon my acceptance into the Archaeology Field School.Yes4. I understand the pre-requisite requirements for SCUBA, DAN Insurance, and CPR/First Aid certification, and have provided documentation of them. Yes5. I acknowledge that I am responsible for providing and maintaining my own personal gear and equipment, as well as transportation to and from the field school, or I have already made alternate arrangements with the Field School Coordinator. Yes6. I understand that I am responsible for contacting Lake Champlain Maritime Museum to correct any errors or omissions, and will provide any necessary clarifications if asked.Yes7. I certify that the above information is true and complete to the best of my knowledge. I acknowledge that my application does not guarantee admission. If accepted, I promise to observe all the rules, regulations, and requirements set by Lake Champlain Maritime Museum to ensure both my safety and the safety of others. I further acknowledge that a violation of these, at the sole discretion of Lake Champlain Maritime Museum staff, may result in my dismissal from the field school without any refund of my tuition.Yes8. I grant to the Lake Champlain Maritime Museum the right to take photographs and video of myself in connection with the field school. I authorize the Lake Champlain Maritime Museum, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that the Lake Champlain Maritime Museum may use my image/voice with or without my name and for any lawful purpose, including such purposes as publicity, illustration, advertising, and Web content, without compensation. [Please note that you will not be disqualified from the field school if you select No]Yes, I grant permissionNo, I do not grant permissionAny additional information or comments?Signature *Clear SignatureToday's DatePreviousMessageSubmit