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.