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Students applying to the Italian Campus must complete this application which is submitted to the OIP. Applications are accepted on a first-come, first-serve basis until the program is full. A complete application will reserve you a place in the program and you will only lose your place (given that all academic and application requirements are met) if you fail to deposit by the deadline.

$950 nonrefundable deposit due:
Deadlines for Fall Semester = March 1; for Spring Semester = September 1

Your place in the program will NOT be held past these deadlines.

Contact Info

First Name:		DORI ID:
Middle Name:		School:
Last Name:		Major:
Gender:	Male Female	Email Address:
Local Phone #:		Date of Birth (DD/MM/YYYY):
Cell #:

Program Information

I am applying for (Check one and fill in year):
	Fall	20
	Spring	20

School Address

Street:		Box/Apt:
City:		State:		Zip Code:

Permanent Address

Street:	Box/Apt:
City:	State:	Zip Code:
Country (If outside US):
Phone:	Alt. Phone:

Emergency Contacts

Primary

First Name:		Home Phone:
Last Name:		Work Phone:
Relationship:		Cell Phone:
Email:

Second

First Name:		Home Phone:
Last Name:		Work Phone:
Relationship:		Cell Phone:
Email:

Academic Information

Current Class Standing:
Class Standing Abroad:
GPA:
Academic Advisor:

Optional Information (for statistical reporting only)

Ethnic Background:
How did you first hear about this study abroad program?

Kim Szczypinski

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