Personal  Information
Name  (First/Last):______________________________________  Preferred  Name:_________________
USCA  ID:_________________________  USCA       E-­‐mail:___________________@email.usca.edu
Local  Address:  _______________________________________________________________________
Permanent  Mailing  Address:  ____________________________________________________________
Home  Phone:__________________________  Cell  Phone:  ________________________________
Birth  Date:  ____________________________  Citizenship:  _______________________________
Academic  Information
Major:  ____________________________  Minor:  ________________________________
Academic  Advisor:  _______________________________________(Name/Department)
Current  GPA:  __________            Class  Year:  ⃝Freshman  ⃝Sophomore  ⃝Junior  ⃝Senior
Graduation  Date:  ________________
Honors  Student:  ______Yes      _______No
Program  Information
USCA  Study  Abroad  Program*:  ______________________________________
* specific  program  requirements  may  apply;  check  on  the  back  of  the  application   for  more  information
Affiliated  Program  (Name  and  Location):____________________________________________________
How  did  you  find  out  about  this  program?  _____________________________________________
Summer  20__
Semester  to  study  abroad?   Fall  20__     Spring  20__    Maymester  20__,
Passport  #  (if  known):  ______________________________________________
Revised  9/2013

Please  address  the  following  questions  on  a  separate  piece  of  paper  and  in  no  more  than  500  words
1) Why   are   you   interested   in   studying   abroad   in   this   particular   country   and   this   particular   program?
2) What  are  your  specific  academic  goals  and  how  do  you  think  the  study  abroad  program  of  your   choice  will  help  you  achieve  them?
Please  provide  contact  information  for  2  individuals  who  we  can  contact  in  case  of  an  emergency.
Name:____________________________________________  Relation  to  you:______________________
Address:_____________________________________________________________________________
Home  Phone:___________________________  Work  Phone:  ______________________________
Cell  Phone:_____________________________  E-­‐mail:___________________________________
Name:____________________________________________  Relation  to  you:______________________
Address:_____________________________________________________________________________
Home  Phone:___________________________  Work  Phone:  ______________________________
Cell  Phone:_____________________________  E-­‐mail:___________________________________
Dear  Student,
the  guardian(s)  you  have  indicated  above.  This  information  will  include,  but  will  not  be  limited  to,  pre-­‐ departure   information   regarding   the   program,   billing   statements   and   other   financial   information,   and   information  regarding  your  whereabouts  while  you  are  abroad.
If   you   choose   not   to   sign   below,   we   will   NOT   be   allowed   to   release   any   type   of   information   to   your   guardian(s)  while  you  are  abroad,  except  in  case  of  an  emergency.
I,   ________________________________________,   permit   the   USCA   International     Programs   Office   to   release  information  to  the  guardian(s)  I  have  indicated  above.
__________________________________________
Student  Signature
_____________________
Date
Revised  9/2013

Have  you  ever  been  convicted  of  a  crime?      Yes      No
If  you  circled  Yes ,  please  explain  the  circumstance  in  detail  in  the  space  provided.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
If  I  accept  a  study  abroad  placement,  I  agree  to  the  following  conditions/statements
1) I  will  take  part  in  all  aspects  of  the  program,  including  orientation  and  evaluation
2) I  will  purchase  health  insurance  coverage  as  required
3) If   I   withdraw   from   the   program   at   any   time   after   accepting   the   placement:   a)   I   may   still   be   obligated  to  pay  the  full  program  fee  at  the  discretion  of  my  home  and  host  institutions  and  b)  I   will  forfeit  my  right  to  receive  benefits  as  a  participant  and  must  reimburse  my  host  institution   for  any  money  advanced  to  me  to  cover  benefits  after  the  date  of  my  withdrawal.
4) If  I  withdraw  prior  to  the  purchase  of  my  airline  ticket,  I  will  be  fully  reimbursed  for  any  down   payments
5) If   I   withdraw   after   the   airline   ticket   has   been   purchased,   I   will   be   responsible   for   the   airline   ticket  and  any  expenses  incurred  to  that  point
6) While   studying   abroad,   I   am   responsible   for   compliance   with   all   conduct   regulations   of   the
University   of   South   Carolina   Aiken.   I   also   understand   that   I   am   subject   to   the   laws   and   regulations  of  the  host  country  and  host  institution  where  I  will  study.
Please   be   aware   that   the   stress   of   travel   and   adjusting   to   a   new   culture   can   exacerbate   physical   or   psychological  conditions  that  may  be  under  control  at  home.  Physical  and  psychological  disorders  can   become   serious   under   the   stresses   of   a   new   environment.   Therefore,   if   you   have   a   physical   or   psychological  condition  it  is  necessary  that  you  meet  with  your  physician  or  counselor  to  discuss  how   studying  abroad  could  affect  your  condition.  Addressing  your  health  issues  prior  to  studying  abroad  will   help  you  to  identify  those  resources  that  will  or  will  not  be  available  at  your  program.
I,  ______________________________________,  have  read  and  understood  the  above  statements.
_________________________________________
Signature
______________________
Date
Revised  9/2013

S PANISH   L ANGUAGE   I MMERSION   P ROGRAM  IN   S PAIN
1) A  minimum  of  2.00GPA  is  required  at  the  time  of  participation
2) A  minimum  of  a  C  in  ASPA101  is  required
3)
Please  provide  the  name  of  three  of  your  past  professors  at  USCA.
Name:  ___________________________________________
Name:  ___________________________________________
Name:  ___________________________________________
4) Please  list  ALL  of  your  previous  Spanish  classes  taken  in  BOTH  high  school  and  university  level.
Please  include  the  instructor’s  name  and  the  grade  you  received  in  the  space  below.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I,  ______________________________,  verify  that  I  have  completed  this  Study  Abroad  application   truthfully  and  to  the  best  of  my  knowledge.  I  understand  that  if  it  is  discovered  that  any  of  the   information  provided  is  false  or  less  than  true,  I  will  accept  any  appropriate  consequences.
_________________________________________
Signature
______________________
Date
Revised  9/2013