Application Form Department of Foreign Languages & Literatures Travel Award (DFLLTA) Name: ________________________________________ Date: ________________________________________ Name of Foreign Study Program: ________________________________ Birth Date: ________________________________________ Major: ________________________________________ Local Address: ________________________________________ Local Phone: ________________________________________ E­mail Address: ________________________________________ Permanent Address ________________________________________ Permanent Phone: ________________________________________ Parent / Guardian: ________________________________________ Current Class: ________________________________________ GPA: ________________________________________ Career Goals: ________________________________________ Extracurricular Activities: ___________________________________________________________ ___________________________________________________________
___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Awards / Honors: ________________________________________ Previous Travel Experience: ________________________________________ Please submit two letters of reference from on­campus faculty or staff members. Note: You must obtain at least one letter from a faculty member. Please attach a copy of your current transcript along with a typed essay (1­2 pages) that includes the following: 1. an explanation of your reason for wanting to study abroad 2. an account of some significant personal challenge you have successfully met 3. an assessment of yourself as a positive representative of the college 4. an explanation of financial need, including information about other sources of assistance that have been either sought and/or granted. If I win the DFLLTA, but fail to complete the program of study abroad specified herein, I agree to return all of the award money to the Department of Foreign Languages & Literatures. Signature of Applicant:________________________________________ Date: ___________________