Harvard Trade Union Program

(Please print or type) 
NAME: (in full)_________________________ Nickname:____________
DATE OF BIRTH:_____________GENDER ______ SOCIAL SECURITY NO:____________________
HOME ADDRESS:______________________________________________________________________
                                (street)                                                                 (city or town)
                                ___________________________________________________________________________________
                                (state) (zip code)                     (country)                                                     (phone) 
PRESENT OCCUPATION:__________________________________
OFFICE ADDRESS: ____________________________________________________________________
                                              (street) ______________________________________________________________________________________
        (city or town)                                      (state)                     (zip code)                             (country) ______________________________________________________________________________________
(phone)                                     (fax)                                                                                 (e-mail)

UNION AFFILIATION:___________________________________________________________________
PRESENT UNION POSITION: _______________________HOW LONG?_____________________
WHO WILL BE PAYING YOUR TUITION & EXPENSES?
(Sponsor):_____________________________________________________    
SPONSOR'S CONTACT: ___________________ TITLE ______________PHONE  ___________
SPONSOR'SADDRESS:____________________________________________________________________
                                        (street)                
                                        __________________________________________________________________ 
                                        (city or town) (state) (zipcode)                               

PAST UNION AFFILIATION(S)/POSITION(S) (Use separate sheet if necessary):
______________________________________________________________________________________

(union) (from-to) (position/s)
_______________________________________________________________________________________
 (union) (from-to) (position/s)
______________________________________________________________________________________
 (union) (from-to) (position/s) 

EDUCATIONAL EXPERIENCE (Please list all schools attended and use a separate sheet if necessary): _____________________________________________________________________________________
 (school) (location) (dates) (degree) _____________________________________________________________________________________
 (school) (location) (dates) (degree) ______________________________________________________________________________________
 (school) (location) (dates) (degree)
PLEASE INDICATE ANY OTHER EXPERIENCE THAT YOU THINK MAY BE RELEVANT: ______________________________________________________________________________________
______________________________________________________________________________________ 
PLEASE INDICATE COMMUNITY ACTIVITIES AND/OR OTHER ORGANIZATION AFFILIATIONS: 
(Use separate sheet if necessary) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 
OTHER PERSONAL INTERESTS: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 
PLEASE ANSWER THE FOLLOWING QUESTION ON A SEPARATE SHEET OF PAPER. PUT YOUR NAME IN THE UPPER RIGHT HAND CORNER OF EACH PAGE AND RETURN IT WITH YOUR COMPLETED APPLICATION. 

1. Please describe how the Harvard University Trade Union Program can be most helpful to your development as a union leader. Your goals for your union or the labor movement are of particular interest. 
   

WHAT TOPICS WOULD YOU LIKE TO SEE COVERED IN THE PROGRAM? (Please list in order of importance) ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 
PLEASE INDICATE HOW YOU HEARD ABOUT THE HARVARD TRADE UNION PROGRAM: ________________________________________________________________________________________ ________________________________________________________________________________________ 
DO YOU SMOKE? (circle one)                                     YES                     NO                           
WOULD YOU PREFER A NON-SMOKING APARTMENT MATE? (circle one)
                YES                     NO                               NO PREFERENCE                                  
________________________________________________________________________________________
signature                                                       date 

Please return this completed application form and your answer to Question 1 to:
 Harvard Trade Union Program
Harvard Law School
125 Mt. Auburn Street, 3rd Floor
 Cambridge, MA 02138 
Phone: 617-495-9265
Fax: 617-496-7359