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PVAMU Education Abroad Application
(Typewritten Only)
Last Name:
First Name:
University ID #:
Gender:
Female
Male
Date of Birth:
Passport Number:
Country of Citizenship:
Area Code and Phone Number: (
Expiration Date:
E-mail Address:
)
Address: Street or P.O. Box
Race/Ethnicity:
Middle Initial:
City
African American
State
American Indian or Alaska Native
Native Hawaiian/Pacific Islander
White
Do you need special assistance with a disability while abroad?
Zip Code
Asian
Hispanic
(specify)
Yes
No
If yes, does International Affairs have your permission to consult with the PVAMU Office of Disability about your disability
and the special assistance needed?
Yes
No
Classification: (Undergraduate)
(Graduate)
Freshman
Sophomore
Master’s
Doctoral
Number of College Hours Completed:
Do you expect to graduate on time?
Cumulative GPA:
Yes
Senior
Academic Advisor:
Minor:
Major:
Junior
No
Number of Hours Applied Toward Degree: _______
Anticipated Graduation Date:
N/A
Yes
No
Have you completed all developmental classes?
(If no, please explain on the Supplemental Information form and include the form with the application.)
Do you authorize the release of information pertaining to your status with the TSI requirements?
Yes
N/A
No
Do you have any incomplete grades from previous terms?
No
Yes
(If yes, please explain on the Supplemental Information form and include the form with the application.)
Were you enrolled at PVAMU last semester as a full-time student?
Are you a transfer student?
No
Yes
Yes
No
If yes, how many hours have you completed at PVAMU?
Have you been charged with academic dishonesty or misconduct (e.g., plagiarism, cheating, etc.) or subject to disciplinary
action for academic dishonesty or misconduct?
No
Yes (If yes, please explain on the Supplemental Information
form and include the form with the application.)
Have you been sanctioned for violating the Code of Student Conduct or do you have a pending case?
(If yes, please explain on the Supplemental Information form and include the form with the application.)
No
Yes
Do you have any legal charges or pending legal charges that could affect your ability to participate in education abroad?
No
Yes ( If yes, please explain on the Supplemental Information form and include the form with the application.)
Do you authorize Academic Affairs and the Office of Student Conduct to provide information about your
conduct and academic records?
Yes
No
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PVAMU Education Abroad Application
(Page 2)
Last Name:
First Name:
Education Abroad Term:
Fall
Spring
University ID #
Summer I
Summer II
Other
Year
Through
Education Abroad Dates: From
Date of Return:
Date of Departure:
Name of Education Abroad Program:
Number of Credit Hours Expected:
Destination:
Type of Program:
PVAMU Faculty-Led
Study Abroad
Program Provider
Internship
Direct Enrollment
Service Learning/Volunteer
Exchange Program
Research
In the space below, please explain why you want to participate in education abroad and what you hope to accomplish. (limit of 1,150 characters)
What is your residency status?
Out of State (Non Resident)
In State (Texas Resident)
Do you currently receive federal, state, or university financial aid?
No If yes, please list the type of
Yes
financial aid that you receive (e.g., Federal Pell Grant, Texas Grant, TPEG, Distinguished Scholarship, etc.).
Will you seek financial aid for the education abroad program?
Yes
No
Attach the following to this application:
-
Official transcript(s)
Color copy of your passport (photo page); if you do not have your passport yet, provide a color copy when it arrives
Education Abroad Budget Worksheet
Pre-Approved Transfer Credit Form (if applicable)
Supplemental Information form if applicable based on your answers (refer to the questions on the application)
Total number of application pages including transcript(s), passport photo page copy, education abroad budget,
Pre-Approved Transfer Credit Form (if applicable) and supplemental information (if applicable)
I certify that the information on this application (including any supplemental information) is correct to the best of my
knowledge and complete.
Printed Name
Signature
Date
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Supplemental Information for PVAMU Education Abroad Application
Complete this form and include it with your application only if you are providing supplemental information
(Typewritten Only)
In the space below, provide the supplemental information. Please indicate the category of supplemental information (e.g.,
TSI requirements; incomplete grades; academic dishonesty or misconduct; student conduct code issues; or legal issues that
can affect your ability to participate in education abroad.
Printed Name
University ID #
Signature
Date
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