DEPARTMENT OF GEOGRAPHY AND GEOLOGY STUDY ABROAD APPLICATION FORM

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:

____ HAWAII (MAY 2005).

Other Program Options are in Development for Summer 2005.

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 March 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 $600 check for the program deposit made payable to "Department of Geography and Geology Study Abroad Program" no later than February 15, 2005, to:

Andrew Wulff and Richard Deal, Program Coordinators
Department of Geography and Geology
Western Kentucky University
Bowling Green, KY 42101-3576
Tel: 270-745-4555
Fax: 270-745-6410
email: andrew.wulff@wku.edu
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