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Tell Us About Yourself

Last Name:*

First Name:*

Middle Name:

Date of Birth:*

Student ID:*

Tell Us About Your Trip

Destination:*

Travel Date/Semester:*

Course Name (if applicable):

Course Prefix:

Course Number:

Professor:

Tell us your contact information

Permanent Mailing Address:

City:

State:

ZIP:

Home Phone Number:

Cell Phone Number:*

ATU Email Address:*

Tell us about your academic history

For year of application, I will be:* Please Select Entering Freshman Freshman Sophomore Junior Senior

Numbers of hours at ATU

Are you planning to be a full time student? Please Select Yes No

Have you declared a major? Please Select Yes No

If yes, please list major & area of interest:

What is your GPA?

Do you receive financial aid? If yes, please list:

Do you speak more than one language? Please Select Yes No

If yes, what language(s)?

Have you studied a foreign language in college or high school? Please Select Yes No

If yes, indicate how many years and what language(s):

Do you have a passport?* Please Select Yes No

How will your travel expenses be paid (ex. scholarships, university funds, personal funds)?

Judicial Review Authorization* Yes NoBy selecting yes, I understand that the Study Abroad Office will request review of my student conduct record, and that I give consent to the Arkansas Tech Department of Student Conduct to release my conduct record to the Study Abroad Office.

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