Study Abroad Application Form

Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

Study Abroad Application Form

APPLICATION DEADLINES:

Fall Semester - March 15th

Winter Session – Oct. 15th

Spring Semester – Oct. 15th

Summer Semester – March 11th

Please Select Your Study Abroad Program

History of Psychology Across Europe March 2022

Student's Full Name*

First Name*

Initial*

Last Name*

Student ID*

Date of Birth

Gender

Male Female

Are You a Transfer Student?

Yes No

Year in School

Freshman Sophomore Junior Senior

GPA

Academic Advisor*

First Name*

Last Name*

Academic Advisor Email*

Major

Citizenship

U.S.

Other: Other Value

Country of Birth

Passport Number

Passport Expiration Date

Passport Image

No File Chosen

File uploads may not work on some mobile devices.

(Please provide a copy of your current passport photo and expiration date with this application)

Email*

Cell Phone

Current Address

Address Line 1

Address Line 2

City

State

ZIP Code

Permanent Address (if different from current address)

Address Line 1

Address Line 2

City

State

ZIP Code

Primary Emergency Contact Information

Name

First Name

Last Name

Relationship

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone

Cell Phone

Work Phone

Secondary Emergency Contact Information

Name

First Name

Last Name

Relationship

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone

Cell Phone

Work Phone

Program Information

Study Abroad Country and City

Study Abroad Program

Institution Abroad

Term(s)

Summer Fall Spring Academic Year (Fall and Spring

Which of the following most influenced your decision to apply for the study abroad program? (Select one only)

Degree Requirements Educational Goals Faculty Member Affordability Career Enhancement Academic Advisor Academic Challenge Personal Growth Foreign Language Study Director of Study Abroad Program Study Abroad Workshop

Do You Plan to Use Financial Aid?

Yes No

If yes, have you filed a FAFSA for the study abroad period?

Yes No

**Please Complete a FAFSA as soon as possible

Are you currently under treatment for any mental or emotional matters

Yes No

Please Describe

Are you currently taking any prescription drugs on a regular basis?

Yes No

Please Describe

References: You must submit at least two letters of reference. We encourage at least one academic reference. The other reference can be from an employer, advisor, coach, and/or supervisor. (Letters from relatives and/or friends are not accepted.. Please have your references return the letters directly to you so you can submit them with this application.

NOTE: if this is a AMC faculty led study abroad trip you do not need to have a reference letter.

Reference Letter 1

No File Chosen

File uploads may not work on some mobile devices.

Reference Letter 2

No File Chosen

File uploads may not work on some mobile devices.

Statement of Interest: Please attach a statement of interest (min. 500 words) explaining why you wish to study abroad. Include in your statement why you have chosen a specific program and country and how you think this experience will benefit you in relation to your future endeavors.

Statement of Interest

No File Chosen

File uploads may not work on some mobile devices.

Certification

Certification 1*

I certify that all of the above information is correct, and I agree to stand by financial, academic and conduct policies and procedures set forth by Anna Maria College and the study abroad program of my choice.

Certification 2*

I certify that I am NOT currently on scholastic probation; or under any disciplinary sanction by Anna Maria College.*

Certification 3*

I certify that I am at least 18 years of age.

Certification 4*

I certify that my passport is good for six (6) months after my expected entry into another country. ( Please provide with this application packet, a copy of your passport)

Certification 5*

I certify that I will comply with the rules, standards, and instructions of the study abroad program and understand that failure to do so may result in being sent home at my (or my parent’s) expense, with no refund. I understand that my participation may be terminated if I am expelled from school or otherwise disciplined by school or civil authorities, or if the Institution, in its sole discretion, determines that my conduct is incompatible with the comfort or welfare of other students.

Certification 6*

I certify that I give permission to Anna Maria College to provide/release any information related to my studying abroad program, health information, and safety information to the person listed as my emergency contact.

Certification 7*

I certify that if accepted, I will participate in all required orientations and complete all evaluations.

Certification 8

By applying to the “Art & Philosophy in Rome, Florence & Pisa” Summer 2018 study abroad program, I express my intention to fully participate on this program such that if I withdraw my application on or after March 12, 2018, a $750 cancellation fee to ACCENT International will apply. ACCENT International, the vendor for this study abroad program, provides logistical support for customized education abroad experiences.

*Please note that the fact that a student is on probation or under sanction will be taken into account when making a decision regarding that student’s application for study abroad and may result in the rejection of an application. As part of the application process, current academic and disciplinary standing will be reviewed. Failure to indicate probationary status will result in withdrawal of support for an application.

Application Fee Payment

I will pay the $250 Application Fee by Check or Cash I will pay the $250 Application Fee Online

Please submit your payment to the Student Accounts Office in Foundress Hall.

Student Signature*

[clear]

Use your mouse or finger to draw your signature above

Application Fee

Name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Phone

Credit Card

Application Fee $