LONGWOOD UNIVERSITY STUDY ABROAD SCHOLARSHP APPLICATION Instructions: Fully complete application, attach typed essay, and obtain required signature from trip organizer. Students participating in long term programs provided by external vendors may use Dr. Bob Frank as signatory. Students are responsible for checking relevant deadlines on the International Studies web pages. Applications must be submitted to The Office of International Affairs by 5:00 on the due date and will not be accepted late. Students must have a minimum of a 2.5 grade point average to be eligible for scholarships. Students participating in multiple short term programs are limited to a maximum of $500 in total funding from this office. Students involved in both short term and long term programs are limited to $900. Second requests may receive a lower priority. This scholarship may not be combined with Presidential or Cormier Honors study abroad scholarships unless specific permission is granted from the Study Abroad Advisory Committee or Director of International Affairs. Program Information: Please Check Appropriate Box: Participating in Semester Study Abroad Program Participating in Student Teaching Program Participating in Short-Term Study Abroad Program (usually intersession or summer term) Name/Location of Program: Approximate Dates of Program: Name of Faculty Director: Signature: Student Information: Legal Name (as appears/will appear on passport): Longwood ID Number (L#): Longwood Mailing Address: Permanent Address: Major: Minor: Cumulative GPA: E-mail Address: Passport Number: Expected Date of Graduation: Cell Phone #: Date of Issue: Date of Expiration: Do you plan to receive your degree from Longwood? YES NO Have you received a previous study-abroad scholarship from Longwood? YES NO YES NO If yes, for what program? Program Dates: Amount: Have you applied/will you apply for funds from another office or department at Longwood? If yes, please specify: Essay Requirement: Please answer the following question and staple it to your application. Essay must be typed and content will be given significant weight. WHAT MAKES YOU A GOOD CANDIDATE FOR A STUDY ABROAD SCHOLARSHIP, AND HOW WILL THE EXPERIENCE SHAPE YOU AS A SCHOLAR AND AS A CITIZEN LEADER? I understand that if I accept this scholarship and then later withdraw from the study program, I am required to return the award in full immediately upon withdrawal. Should I fail to complete the program, fail to attend classes regularly, or fail to submit assigned work, I will be obligated to refund the entire amount of the scholarship immediately upon returning home. I am aware that failure to comply will result in a hold being placed on my academic record and honor board charges may result. I also confirm that the above information is current and accurate to the best of my knowledge. ___________________________________________ Signature __________________________________ Date