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Fourth Year Elective This form is only to be used by an elective director when establishing a new elective. Please be sure to fill this form out completely and include your signature before forwarding
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Please give the following information: (1) name of school of which you are an undergraduate or graduate student in (2) address of attendance for the school year you are a student (3) phone number for your school (4) email address (5) if you are leaving the school in the 2016-17 school year, please explain why (6) year you began your undergraduate or graduate studies at your school: (a) 2015 (b) 2014 (c) 2013 (d) 2012 (e) 2011 (f) 2010 (g) 2009 (h) 2008 (i) 2007 I. I hereby promise to serve in this elective for four (4) years commencing January 1, 2017. JOSEPH SANDERS, SACRAMENTO WITHOUT PREJUDICE LAST AFFILIATE OF ASSOCIATED SCHOOLS, UNIVERSITY FIFTH YEAR ELECTIVE FOR STUDENT DIRECTOR. Your name and telephone number must be included on the form you submit. If you are applying to replace an older student, please provide a copy of the university/college letter or confirmation of your current position. If you would like your name removed from the list, please provide us with a request in the required fields. The form should be emailed to: director.application.edu FIFTH YEAR ELECTIVE TITLE. Please give the following information: (1) name of school of which you are an undergraduate or graduate student in (2) address of attendance for the school year you are a student (3) phone number for your school (4) email address (5) if your term will end after your term at the school ends, please explain why (6) year you began your undergraduate or graduate studies at your school: (a) 2015 (b) 2014 (c) 2013 (d) 2012 (e) 2011 (f) 2010 (g) 2009 (h) 2008 (i) 2007 (Please include an explanation of why you should be appointed. You may want to include your thesis work if you are applying for a Ph.D.) (ii) I hereby promise to serve in this elective for four (4) years commencing January 1, 2017. DUSTIN A. WELDON, UNIVERSITY (NOTE: This is a letter of recommendation rather than an actual appointment request.

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