MIME-Version: 1.0
Content-Location: file:///C:/2A64CAAD/TeacherAwardForm.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"

<html xmlns:v=3D"urn:schemas-microsoft-com:vml"
xmlns:o=3D"urn:schemas-microsoft-com:office:office"
xmlns:w=3D"urn:schemas-microsoft-com:office:word"
xmlns:st1=3D"urn:schemas-microsoft-com:office:smarttags"
xmlns=3D"http://www.w3.org/TR/REC-html40">

<head>
<meta http-equiv=3DContent-Type content=3D"text/html; charset=3Dus-ascii">
<meta name=3DProgId content=3DWord.Document>
<meta name=3DGenerator content=3D"Microsoft Word 11">
<meta name=3DOriginator content=3D"Microsoft Word 11">
<link rel=3DFile-List href=3D"TeacherAwardForm_files/filelist.xml">
<title>MCLASC Memorial Teacher Award</title>
<o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags"
 name=3D"PostalCode"/>
<o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags"
 name=3D"State"/>
<o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags"
 name=3D"City"/>
<o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags"
 name=3D"Street"/>
<o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags"
 name=3D"address"/>
<o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags"
 name=3D"PlaceType"/>
<o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags"
 name=3D"PlaceName"/>
<o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags"
 name=3D"place"/>
<!--[if gte mso 9]><xml>
 <o:DocumentProperties>
  <o:Author>Santa Monica College</o:Author>
  <o:LastAuthor>Santa Monica College</o:LastAuthor>
  <o:Revision>3</o:Revision>
  <o:TotalTime>6</o:TotalTime>
  <o:Created>2008-09-11T16:43:00Z</o:Created>
  <o:LastSaved>2008-09-11T16:44:00Z</o:LastSaved>
  <o:Pages>2</o:Pages>
  <o:Words>122</o:Words>
  <o:Characters>702</o:Characters>
  <o:Company>Santa Monica College</o:Company>
  <o:Lines>5</o:Lines>
  <o:Paragraphs>1</o:Paragraphs>
  <o:CharactersWithSpaces>823</o:CharactersWithSpaces>
  <o:Version>11.9999</o:Version>
 </o:DocumentProperties>
</xml><![endif]--><!--[if gte mso 9]><xml>
 <w:WordDocument>
  <w:SpellingState>Clean</w:SpellingState>
  <w:GrammarState>Clean</w:GrammarState>
  <w:PunctuationKerning/>
  <w:ValidateAgainstSchemas/>
  <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
  <w:IgnoreMixedContent>false</w:IgnoreMixedContent>
  <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
  <w:Compatibility>
   <w:SelectEntireFieldWithStartOrEnd/>
   <w:UseWord2002TableStyleRules/>
  </w:Compatibility>
  <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel>
 </w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
 <w:LatentStyles DefLockedState=3D"false" LatentStyleCount=3D"156">
 </w:LatentStyles>
</xml><![endif]--><!--[if !mso]><object
 classid=3D"clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=3Dieooui></objec=
t>
<style>
st1\:*{behavior:url(#ieooui) }
</style>
<![endif]-->
<style>
<!--
 /* Font Definitions */
 @font-face
	{font-family:Wingdings;
	panose-1:5 0 0 0 0 0 0 0 0 0;
	mso-font-charset:2;
	mso-generic-font-family:auto;
	mso-font-pitch:variable;
	mso-font-signature:0 268435456 0 0 -2147483648 0;}
@font-face
	{font-family:Verdana;
	panose-1:2 11 6 4 3 5 4 4 2 4;
	mso-font-charset:0;
	mso-generic-font-family:swiss;
	mso-font-pitch:variable;
	mso-font-signature:536871559 0 0 0 415 0;}
 /* Style Definitions */
 p.MsoNormal, li.MsoNormal, div.MsoNormal
	{mso-style-parent:"";
	margin:0in;
	margin-bottom:.0001pt;
	mso-pagination:widow-orphan;
	font-size:12.0pt;
	font-family:"Times New Roman";
	mso-fareast-font-family:"Times New Roman";}
a:link, span.MsoHyperlink
	{color:blue;
	text-decoration:underline;
	text-underline:single;}
a:visited, span.MsoHyperlinkFollowed
	{color:purple;
	text-decoration:underline;
	text-underline:single;}
span.SpellE
	{mso-style-name:"";
	mso-spl-e:yes;}
span.GramE
	{mso-style-name:"";
	mso-gram-e:yes;}
@page Section1
	{size:8.5in 11.0in;
	margin:1.0in 1.25in 1.0in 1.25in;
	mso-header-margin:.5in;
	mso-footer-margin:.5in;
	mso-paper-source:0;}
div.Section1
	{page:Section1;}
 /* List Definitions */
 @list l0
	{mso-list-id:1114443845;
	mso-list-type:hybrid;
	mso-list-template-ids:-775765946 67698691 67698691 67698693 67698689 67698=
691 67698693 67698689 67698691 67698693;}
@list l0:level1
	{mso-level-number-format:bullet;
	mso-level-text:o;
	mso-level-tab-stop:.5in;
	mso-level-number-position:left;
	text-indent:-.25in;
	font-family:"Courier New";}
ol
	{margin-bottom:0in;}
ul
	{margin-bottom:0in;}
-->
</style>
<!--[if gte mso 10]>
<style>
 /* Style Definitions */
 table.MsoNormalTable
	{mso-style-name:"Table Normal";
	mso-tstyle-rowband-size:0;
	mso-tstyle-colband-size:0;
	mso-style-noshow:yes;
	mso-style-parent:"";
	mso-padding-alt:0in 5.4pt 0in 5.4pt;
	mso-para-margin:0in;
	mso-para-margin-bottom:.0001pt;
	mso-pagination:widow-orphan;
	font-size:10.0pt;
	font-family:"Times New Roman";
	mso-ansi-language:#0400;
	mso-fareast-language:#0400;
	mso-bidi-language:#0400;}
</style>
<![endif]--><!--[if gte mso 9]><xml>
 <o:shapedefaults v:ext=3D"edit" spidmax=3D"2050"/>
</xml><![endif]--><!--[if gte mso 9]><xml>
 <o:shapelayout v:ext=3D"edit">
  <o:idmap v:ext=3D"edit" data=3D"1"/>
 </o:shapelayout></xml><![endif]-->
</head>

<body lang=3DEN-US link=3Dblue vlink=3Dpurple style=3D'tab-interval:.5in'>

<div class=3DSection1>

<p class=3DMsoNormal><span lang=3DES style=3D'mso-ansi-language:ES'><o:p>&n=
bsp;</o:p></span></p>

<span lang=3DES style=3D'font-size:12.0pt;font-family:"Times New Roman";mso=
-fareast-font-family:
"Times New Roman";mso-ansi-language:ES;mso-fareast-language:EN-US;mso-bidi-=
language:
AR-SA'><br clear=3Dall style=3D'mso-special-character:line-break;page-break=
-before:
always'>
</span>

<p class=3DMsoNormal><b style=3D'mso-bidi-font-weight:normal'><span lang=3D=
ES
style=3D'mso-ansi-language:ES'><o:p>&nbsp;</o:p></span></b></p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:449.6pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-yfti-tbllook:480;mso-padding-alt:0in 5.4pt 0in 5=
.4pt;
 mso-border-insideh:.5pt solid windowtext;mso-border-insidev:.5pt solid win=
dowtext'>
 <tr style=3D'mso-yfti-lastrow:yes;height:31.0pt'>
  <td width=3D96 valign=3Dtop style=3D'width:1.0in;border:solid windowtext =
1.0pt;
  mso-border-alt:solid windowtext .5pt;padding:0in 5.4pt 0in 5.4pt;height:3=
1.0pt'>
  <p class=3DMsoNormal><b style=3D'mso-bidi-font-weight:normal'><span lang=
=3DES
  style=3D'mso-ansi-language:ES'><o:p>&nbsp;</o:p></span></b></p>
  </td>
 </tr>
</table>

<p class=3DMsoNormal style=3D'text-indent:.5in'><b style=3D'mso-bidi-font-w=
eight:
normal'><span lang=3DES style=3D'mso-ansi-language:ES'><span style=3D'mso-t=
ab-count:
9'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></b><b
style=3D'mso-bidi-font-weight:normal'><span lang=3DES style=3D'font-size:8.=
0pt;
mso-ansi-language:ES'><span
style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span><span style=3D'mso-tab-count:3'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></b><b
style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt'>Rank<=
/span><span
style=3D'mso-tab-count:2'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><span
style=3D'mso-tab-count:9'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span=
><span
style=3D'mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp; </span><span
style=3D'mso-tab-count:2'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp; </span><span
style=3D'mso-tab-count:2'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp; </span><span
style=3D'mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp; </span><span
style=3D'mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp; </span><span
style=3D'mso-tab-count:2'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp; </span></b><b
style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt'>For o=
ffice
use only<o:p></o:p></span></b></p>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;text-indent:=
.5in'><b
style=3D'mso-bidi-font-weight:normal'><o:p>&nbsp;</o:p></b></p>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;text-indent:=
.5in'><b
style=3D'mso-bidi-font-weight:normal'><o:p>&nbsp;</o:p></b></p>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;text-indent:=
.5in'><b
style=3D'mso-bidi-font-weight:normal'><o:p>&nbsp;</o:p></b></p>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;text-indent:=
.5in'><b
style=3D'mso-bidi-font-weight:normal'>MCLASC Memorial Teacher Award<span
style=3D'mso-tab-count:1'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp; </span><o:p></o:p></b></p>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><b style=3D=
'mso-bidi-font-weight:
normal'><o:p>&nbsp;</o:p></b></p>

<p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><b style=3D=
'mso-bidi-font-weight:
normal'>APPLICATION FORM<o:p></o:p></b></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<div style=3D'mso-element:para-border-div;border:none;border-bottom:solid w=
indowtext 1.5pt;
padding:0in 0in 1.0pt 0in'>

<p class=3DMsoNormal style=3D'border:none;mso-border-bottom-alt:solid windo=
wtext 1.5pt;
padding:0in;mso-padding-alt:0in 0in 1.0pt 0in'><o:p>&nbsp;</o:p></p>

</div>

<p class=3DMsoNormal>Last Name<span style=3D'mso-tab-count:6'>&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp; </span>First
Name</p>

<p class=3DMsoNormal><span style=3D'font-size:10.0pt;font-family:Verdana'><=
o:p>&nbsp;</o:p></span></p>

<div style=3D'mso-element:para-border-div;border:none;border-bottom:solid w=
indowtext 1.5pt;
padding:0in 0in 1.0pt 0in'>

<p class=3DMsoNormal style=3D'border:none;mso-border-bottom-alt:solid windo=
wtext 1.5pt;
padding:0in;mso-padding-alt:0in 0in 1.0pt 0in'><span style=3D'font-size:10.=
0pt;
font-family:Verdana'><o:p>&nbsp;</o:p></span></p>

</div>

<p class=3DMsoNormal><span style=3D'mso-bidi-font-size:10.0pt'>Address<o:p>=
</o:p></span></p>

<div style=3D'mso-element:para-border-div;border:none;border-bottom:solid w=
indowtext 1.5pt;
padding:0in 0in 1.0pt 0in'>

<p class=3DMsoNormal style=3D'border:none;mso-border-bottom-alt:solid windo=
wtext 1.5pt;
padding:0in;mso-padding-alt:0in 0in 1.0pt 0in'><span style=3D'font-size:10.=
0pt;
font-family:Verdana'><o:p>&nbsp;</o:p></span></p>

</div>

<p class=3DMsoNormal><span style=3D'mso-bidi-font-size:10.0pt'>Phone<span
style=3D'mso-tab-count:6'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp; </span>email<o:p></o:p></span></p>

<div style=3D'mso-element:para-border-div;border:none;border-bottom:solid w=
indowtext 1.5pt;
padding:0in 0in 1.0pt 0in'>

<p class=3DMsoNormal style=3D'border:none;mso-border-bottom-alt:solid windo=
wtext 1.5pt;
padding:0in;mso-padding-alt:0in 0in 1.0pt 0in'><span style=3D'font-size:10.=
0pt;
font-family:Verdana'><o:p>&nbsp;</o:p></span></p>

</div>

<p class=3DMsoNormal><span style=3D'mso-bidi-font-size:10.0pt'>School Affil=
iation<o:p></o:p></span></p>

<p class=3DMsoNormal><span style=3D'font-size:10.0pt;font-family:Verdana'><=
o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal><span style=3D'mso-bidi-font-size:10.0pt'>____________=
________________
<o:p></o:p></span></p>

<p class=3DMsoNormal><span style=3D'mso-bidi-font-size:10.0pt'>MCLASC Membe=
r since<o:p></o:p></span></p>

<p class=3DMsoNormal><span style=3D'font-size:10.0pt;font-family:Verdana'><=
o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal><span style=3D'font-size:10.0pt;font-family:Verdana'><=
o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal><span style=3D'mso-bidi-font-size:10.0pt'>On a separat=
e sheet
please write a one-page proposal that indicates your plans for the use of t=
hese
funds and how your activity will enhance and/or improve your teaching. Plea=
se
include the nature of the activity, and a time frame for the completion.<sp=
an
style=3D'mso-spacerun:yes'>&nbsp; </span><o:p></o:p></span></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal>Please mail the completed application and proposal to:=
<span
style=3D'mso-tab-count:1'>&nbsp; </span>Rebecca Anderson</p>

<p class=3DMsoNormal><span style=3D'mso-tab-count:8'>&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp; </span><span
class=3DGramE>c/o</span> Modern Language Dept.</p>

<p class=3DMsoNormal><span style=3D'mso-tab-count:8'>&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp; </span><st1:place
w:st=3D"on"><st1:PlaceName w:st=3D"on">Santa Monica</st1:PlaceName> <st1:Pl=
aceType
 w:st=3D"on">College</st1:PlaceType></st1:place></p>

<p class=3DMsoNormal><span style=3D'mso-tab-count:8'>&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp; </span><st1:Street
w:st=3D"on"><st1:address w:st=3D"on">1900 Pico Blvd.</st1:address></st1:Str=
eet></p>

<p class=3DMsoNormal><span style=3D'mso-tab-count:8'>&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp; </span><st1:place
w:st=3D"on"><st1:City w:st=3D"on">Santa Monica</st1:City>, <st1:State w:st=
=3D"on">CA</st1:State>
 <st1:PostalCode w:st=3D"on">90405</st1:PostalCode></st1:place></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal>____________________________<span style=3D'mso-tab-cou=
nt:3'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp; </span>___________________________
</p>

<p class=3DMsoNormal>Signature<span style=3D'mso-tab-count:6'>&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&=
nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbs=
p;&nbsp;&nbsp;&nbsp;&nbsp; </span>Date</p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<div style=3D'mso-element:para-border-div;border:none;border-bottom:solid w=
indowtext 1.5pt;
padding:0in 0in 1.0pt 0in'>

<p class=3DMsoNormal style=3D'border:none;mso-border-bottom-alt:solid windo=
wtext 1.5pt;
padding:0in;mso-padding-alt:0in 0in 1.0pt 0in'><o:p>&nbsp;</o:p></p>

</div>

<p class=3DMsoNormal>For office use only:</p>

<p class=3DMsoNormal>Date received<span style=3D'mso-tab-count:5'>&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nb=
sp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><=
/p>

</div>

</body>

</html>
