Application for The Department of Geography and Geology Study Abroad Program

ONLY TYPED APPLICATIONS WILL BE CONSIDERED


Please check the program to which you are applying:

     ____ BAHAMAS (January 7, 2006 - January 16, 2006).

Other Program Options are in Development for Summer 2006.
Last Name: First Name: Middle Name or Initial:
Present Mailing Address:
Present Phone Number: E-mail Address:
Permanent Mailing Address:
Permanent Phone Number:
Date of Birth: Citizenship:
____Male      ____Female Student ID Number:
Present College or University:
Present Class:  ____ FR     ____ SO     ____ JR     ____ SR     ____ GR    ____ Community/Other
Major/Minor:
Cumulative Grade Point Average on 4.0 Scale:______    Please request an unofficial transcript from all non-WKU colleges and universities attended.   Transcripts must be mailed directly to the Department Head, Department of Geography and Geology, Western Kentucky University, Bowling Green, KY 42101-3576.
Emergency Contact Name:
Address:
Telephone:
I am applying as a(n):  ____ Undergraduate     ____ Graduate      ____ Community/Continuing Education
Please list the courses you are interested in taking in order of your preference.  (This list is not final; official registration will take place in October 2005.) 1.
2.
3.
4.
If accepted for participation into the program, do you wish to travel on the group flight/itinerary or make your own flight arrangements?     
 ____ Group    ____ Independent    (Note: The choice you make on this application will be binding upon acceptance.  If you choose to make your own arrangements, please call the Department of Geography and Geology office for the amount of flight credit allowed.)
Special requests regarding accommodations [roommates; smoking; special diet (vegetarian, etc.); morning/night person, etc.]
Are you a smoker?  ____ Yes      ____ No
Medical information:  (Please list any medical conditions and explain in detail, using a separate sheet if necessary.  Failure to disclose any and all medical conditions may result in removal from the program.  Doctor's letter releasing you to participate may be requested.)

 
Name of person writing letter of recommendation:
From whom did you learn of this program?
We would encourage you to discuss the particulars of this program with your emergency contact.  May we send duplicate materials relating to this program sent to your emergency contact if you are accepted? ____Yes     ____ No
Please write an essay indicating why you would like to study in the Department's Study Abroad Program (you can attach a separate page).

 

 

 

 

 

 

 

 

 

 
Note:  Failure to provide requested information will cause this application not to be considered.

I have correctly completed all information.

_______________________________________________
Applicant's Signature

_______________________________________________
Signature, Academic advisor.
Please return this form with a $100 check for the program deposit made payable to "Department of Geography and Geology Study Abroad Program" no later than October 15, 2005, to:

Fred Siewers, Program Director
Department of Geography and Geology
Western Kentucky University
Bowling Green, KY 42101-3576
Tel: 270-745-4555
Fax: 270-745-6410
email: fred.siewers@wku.edu
The final payment of $1300-$1500 will be due no later than November 15, 2005. Check with Dr. Siewers for the final details.
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