APPLICATION TO STUDY ABROAD,
INTERN, OR STUDENT TEACH ABROAD
PERSONAL IDENTIFICATION
Name (exactly as it appears/will appear on your passport):
Date of SA Application:
Surname/Family Name
First Name
Middle/Other
Alverno College Student I.D. No.: _______________________
Date of Birth:
mm/dd/yyyy
City/State of Birth:
Country of Birth:
Country of Citizenship:
Country of legal permanent residence:
Attach a copy of the photo and data page of your passport to this application form. If you do not yet have
a passport, bring a copy of the data page to the IIC as soon as you obtain it.
ADDRESS, TELEPHONE AND E-MAIL
If residing on-campus, indicate your current residence hall and room number:
If residing off-campus indicate your current address:
Street address
City
State
Telephone: Cell
Zip
Country
Home
Work
Alverno E-mail: ____________________________________________
Other E-mail
Please indicate your permanent address if different from above:
Street address
City
State
Zip
Please tell us which address you prefer us to use to mail items to you: _______Current
Country
______Permanent
LANGUAGES
Is English your native language? ____Yes
____ No
If no, what is your native language?
List any other languages, besides English, which you read, write and speak fluently:
ALVERNO COLLEGE INFORMATION AND STATUS
Advisor(s):
Indicate as applicable:
Major: _____________
nd
2 Major: ____________
Support: _____________
nd
2 Support: ___________
Indicate your expected graduation date: ____________________
I meet the following criteria for Study Abroad (Please check): I am
An independent learner with a consistent record of academic achievement;
Capable of living and working in new and different surroundings by being able to adjust, adapt, be flexible and
respond to new situations;
In good academic standing at the time of my application;
In good financial aid standing;
At an advanced (upper level) status at the time of study abroad (or approved by advisors);
ATTACH a current copy of your academic evaluation, validation matrix, and class schedule as well as a current résumé.
I am a member of an Alverno sports team:
Yes
No
NOTE: In order to receive final approval to study abroad:
 You must provide proof of financial support
o no later than February 1 if you plan to study abroad in the summer;
o no later than June 1 if you plan to study abroad in the fall, and
o no later than November 1 if you plan to study abroad in the upcoming spring semester.

You must not have any holds on your records and be in good standing with all of the following departments: 1) Your
major department(s); 2) Academic Advising; 3) Assessment Center; 4) Business Office; 5) Financial Aid; 6) Student
Services. If you do not know your status with each of these departments, take the time to learn your status.
PERSONAL ESSAY OF PURPOSE FOR STUDYING ABROAD
Attach an essay addressing the following listed below. Your essay will be evaluated based on your ability to communicate
that you:
a) Have seriously considered your goals for study abroad and how study abroad relates to your program of study;
b) Thoughtfully identified factors that affect intercultural experiences; and
c) Have completed at least some basic research about the program/country in which you plan to study.
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1. Why are applying for study abroad? Discuss your goals and what you hope to learn personally and professionally.
2. Describe your ideal intercultural experience either abroad or in the United States. Explain why the experience you
describe would be “ideal.”
3. How do you expect your study abroad experience to complement your course of study at Alverno? Provide specific
examples of how being in the program/country you are applying for will benefit your study.
4. Your international experience will make you a special resource to the Alverno College community. How do you plan to
use your experience to enhance the College upon your return? Provide one or two specific ideas.
NOTE: You should also provide a copy of this statement to the persons from whom you have requested an evaluation and
letter of recommendation.
PLANS FOR STUDYING ABROAD
List the name of the university or program you are planning to attend and the country in which you will be studying:
Please indicate when you want to study abroad:
Beginning:
Ending:
Month and Year
Month and Year
What are your anticipated areas of academic study while abroad?
___________________________________
___________________________________
___________________________________
___________________________________
Are you applying for an international internship opportunity? ____ Yes ____ No
If yes, it may not be necessary for you to complete this form! Please contact the Internship Department first!
Are you applying for an international student teaching placement? ____ Yes ____ No
You must apply one full year in advance to obtain a student teaching placement.
RECOMMENDATIONS
Please list the names of the Alverno faculty or staff who will provide your:
1.
Faculty Evaluation: ________________________________________________________________________________
2.
Letter of Recommendation:__________________________________________________________________________
CERTIFICATION
I certify that the information I have provided in this application is true and complete.
Signature:
Date:
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