STUDY IN SOUTH AFRICA APPLICATION FORM
(Please type)
Last Name:____________________________________ First Name:______________________ M.I.:_____
Social Security Number:__________________________ Date of Birth:_______________________________
Passport Number________________________________Gender:
oMale
oFemale
(if you do not have a valid passport, apply for one immediately)
Citizen of the U.S.? o yes o no
If no, what country? (this is required)__________________
Are you a Missouri resident? o yes o no
Note: Nonresidents of Missouri must provide a copy of your driver’s
license.
If “No” above, do you have permanent resident (P.R.) status
in the U.S.?
o yes o no
If yes to P.R. status, please enclose a copy of green card.
We are required by the Federal government to solicit certain demographic information to meet federal reporting requirements. The information below will
not be used in a discriminatory manner. It is not required.
What is your ethnicity?
oHispanic or Latino
oNon-Hispanic or Non-Latino
Ethnic origin:
o American Indian or Native Alaskan
o Asian (includes Chinese, Filipino, Japanese, Korean, Thai, and Asian Indian)
o Asian (other)
o Black or African-American
o White/Caucasian
o Hawaiian/Pacific Islander
Current address:_____________________________________________________________________
Current Phone:_________________________ E-mail:______________________________________
Fax:__________________________________ Cell Phone:__________________________________
Address after May 15:_________________________________________________________________
Phone after May 15:__________________________________________________________________
Person to contact in case of emergency:
Name:________________________________ Telephone Number:____________________________
Address:___________________________________________________________________________
Relationship:________________________________________________________________________
Current year in law school: o 1L o 2L
Current Law School:___________________________________ Registrar Name:______________________
Law School Address & Phone #:_______________________________________________________________
________________________________________________________________________________________
Signature____________________________________Date__________________________________
Please return this form with the items listed to:
Study in South Africa
University of Missouri School of Law
203 Hulston Hall
Columbia, MO 65211
22 positions available.
Applications will be taken on a first-come, first-served basis.
• letter of good standing from registrar or dean
• $50 nonrefundable application fee, payable to
University of Missouri School of Law
• $250 deposit, payable to University of Missouri
School of Law. This deposit is refundable if a
student withdraws before Jan. 20, 2015.
For more information, visit law.missouri.edu/sap