Study Abroad Program:_________________________

Name: ____________________________________Student ID:______________________

Address:  ________________________________________________________________

                                   (Street)                                                          (City)                                                    (State)

Phone:  _________________       _________________   Email: ______________________

                     (Home)                                           (Work)

Faculty references: Please have two faculty members who know you, and who would recommend you for this work-scholarship position, sign your application.

_________________________________          __________________________________

                  (Faculty Signature)                                                                             (Faculty Signature)

Date_____________________________           Date______________________________

Do you know if you are eligible for federal work-study? _______ Yes ________No

Are you currently receiving a scholarship of any kind, and if so, which scholarships? Any scholarships for study abroad?

Are there any special circumstances we should know about in considering your application?

Do you have any special skills or interests that could help us place you in a work-study?

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