POL 40995 and History 49195: Study Abroad
Modern Germany: Politics, History and Culture
Kent State University
Summer 2016
Due December 15
Please submit your completed application with the $60 non-refundable application fee (Please make
check payable to Kent State University/OGE) to Mark Cassell, Department of Political Science (check
will ONLY be cashed if student is accepted and attends).
Mr/Mrs/Ms ________________________________________________________________________
Last Name
First Name
Middle Initial
Banner ID ________________________
Birth date _______________
_________________________________________________________________________________
Address
City
State
Zip
Phone: (____)___________ Alternate Phone: (____)__________ Email____________________
Is this your permanent address? Yes No
If no, please write your permanent address on the back of this application.
Individual to be notified in the event of an emergency:
Name____________________________________________Relationship:______________________
Address___________________________________________________________________________
Number and street
City
State
Zip
Phone: (______)______________________
Alternate Phone: (_____)___________________
Ethnic information is used for reporting purposes. Please circle one or more as appropriate.
African American
Hispanic or Latino
American Indian or Alaskan Native
Multiracial
Caucasian/White
Non-U.S. Citizen
Asian American or Pacific Islander American
Cumulative GPA _______
Major_____________________ Minor _________________________
Do you receive Financial Aid? YES
NO
If Yes, what aid do you receive?
Expected class standing during study abroad semester:
Fresh.
Soph.
Jr.
Sr.
Passport No._____________________ Issuing Country____________ Expiration _____________
Note: Applicants who are not U.S. citizens should contact the Office of International Affairs for further
information regarding visa requirements.
Office of Global Education
www.kent.edu/global
****** Please fill out the reverse side******
1. What are three outcomes you hope to accomplish from participating in this Study
Abroad Program?
2. Do you have any prior experience traveling outside the country? If yes, describe
your experience.