Study Abroad Application
PART A: General Information
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? _____________________________________________
Semester to study abroad?
Fall 20__
Spring 20__
Maymester 20__,
Passport # (if known): ______________________________________________
Revised 9/2013
Summer 20__
PART B: Statement of Purpose
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?
PART C: Emergency Contact Information
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,
By signing your name below, you permit USCA’s International Programs Office to release information to
the guardian(s) you have indicated above. This information will include, but will not be limited to, predeparture 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
Revised 9/2013
_____________________
Date
History of Criminal Behavior
Have you ever been convicted of a crime? Yes No
If you circled Yes, please explain the circumstance in detail in the space provided.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Required Statement of Understanding
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
Revised 9/2013
______________________
Date
Specific Program Requirements
SPANISH LANGUAGE IMMERSION PROGRAM IN SPAIN
1) A minimum of 2.00GPA is required at the time of participation
2) A minimum of a C in ASPA101 is required
3) Professor References:
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.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Application Verification
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
803-641-3728 (Attn: International Programs)
Revised 9/2013
______________________
Date