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Statement of Interest in Study Abroad

**Required field

Name:

Phone #:

E-mail:

Campus Box:

Major(s):

Minor(s):

Parent Name:

Parent Phone #:

Parent Address:

Health Insurance:

Preferred language of instruction while abroad:

Current or most recent language course (language, number, and term):

Country (or countries) under consideration:

University/School Program abroad (if known):

Field of study while abroad (specific coursework desired, if any):

Year/Term of anticipated Study Abroad:

Current year in college:

Previous travel abroad? Yes or No

If yes, where?

Do you have a current passport? Yes or No

Expiration Date(mm/yy):

Preferred housing arrangements Family stay or Dormitory/Apt
(Typically, we encourage our students to participate in the host family experience)