APPLICATION FOR BUSINESS SERVICE LEARNING TRIPS
Name:
_________________ Email:
MUID Number:
Local Phone:
________________________
Cell Phone:
For which trip(s) are you available to participate?
Current year in school:
Jr.
Winter break Country:__
Spring break Country:__
Sr.
_
_
Grad
Area(s) of study and/or other degrees received:
University
Major/Minor
Year of Completion (or
anticipated)
Please mark the following Business Skills if either applies:
Entrepreneurship
Real Estate
Human Resources
Operations & Supply
Chain
Business Admin.
Business Economics
Information
Technology
International Business
Accounting
Finance
Marketing
What is your Spanish-speaking ability (select one):
1
2
3
4
5
6
7
8
9
10
1 = single words, not conversational
5 = some conversation ability
10 = fluent, conversation ability in all situations
** List any previous Spanish language training or experiences:
*PLEASE ATTACH A COPY OF PICTURE PAGE OF YOUR PASSPORT TO THIS FORM
Return the document to Dr. Heather Kohls, DS 405
Page 1 of 7
Please briefly answer the following questions (extend to an additional sheet if desired).
1. What other extracurricular activities, hobbies, leadership roles, volunteering, etc. are you
involved in? (How do you spend your free time?)
2. List personal qualities, jobs, life experiences, interests, etc. that you feel provide a good
foundation for your participation in this experience. What can you bring to our team?
3. What do you hope to gain from this experience?
4. If you have participated in a similar project/trip(s), how do you feel you contributed to the
success of the group? What, if anything, would you do differently if you were to participate
again?
** Applicants MUST be available to attend the mandatory meetings (dates will be determined by
majority group availability) in order to be eligible for participation in any AGBL trip.
By signing below you are willing to make this commitment as part of your obligation as a
participant. All students selected to participate are expected to assist with group project planning
and to attend schedule meetings and other activities.
**If selected, a $500 non-refundable deposit and a signed commitment form is due at the first
organizational meeting. You will receive the commitment form as an attachment when you
are accepted.
Signature: ___________________________________
Date:
Page 2 of 7
Additional Questions for Spanish speakers, who Could Act as Translators for the Group
1. Explica en que situaciones has podido poner en práctica tu habilidad en el empleo de español
de negocios.
2. Imagina que es el último día de brigada en Guatemala, tras una semana trabajando con un
grupo de mujeres que se dedica a la fabricación de joyas para la venta en el mercado local. Ellas
sueñan con exportar sus productos a los Estados Unidos en los próximos meses, pero el grupo
piensa que esto no es un objetivo realista, y que deben concentrarse en la venta en el propio país,
quizás centrándose en las localidades más turísticas. Además, el grupo ha observado que los
diseños de este grupo de mujeres no son tan atractivos como los de la competencia, y que tienden
a pagar mayores precios por los materiales que la competencia. Escribe, con tus propias palabras,
la presentación de las conclusiones que harías para el grupo de mujeres. Puedes añadir elementos
adicionales que sean coherentes con el caso, si ayudan en la presentación.
Page 3 of 7
EMERGENCY CONTACT/MEDICAL INFORMATION
NAME OF PROJECT: Applied Global Business Learning Service Trip
Destination:
Date (Month/Year):
NAME (As it appears on your passport):
Passport Number:
Expiration date:
EMERGENCY CONTACT PERSON
Name:
Relationship:
Day Phone:
Evening Phone:
ALTERNATE CONTACT (will be used if unable to contact the person listed above)
Name:
Relationship:
Day Phone:
Evening Phone:
PERSONAL PHYSICIAN (optional):
Office Phone Number:
MEDICAL INSURANCE COMPANY:
Policy #:
Phone #:
BRIEF MEDICAL HISTORY (SURGERIES, CONDITIONS):
MEDICATIONS CURRENTLY TAKING (INCLUDE DOSAGE/FREQUENCY):
ALLERGIES:
OTHER PERTINENT INFORMATION:
DISCLAIMER: Marquette University is not responsible for monitoring medications, medical conditions, diets,
food allergies or medication allergies and will only use this information provided in an emergency.
Page 4 of 7
Program Duration
Please Print
Personal information
Last name
First name
Marquette University ID
Date of birth (MM/DD/YY)
Citizenship:
U.S. citizen
Permanent resident
Passport number
not a U.S. citizen or permanent resident
Valid until
Check here if you are in the process of applying for your passport
Permanent address
Address
City State ZIP
)
-
)
-
Home telephone (
Current address
Address
City State ZIP
Home telephone (
E-mail address
Note: please notify us of your new address if it will change between now and the time you study abroad.
Emergency contact
Name
Relationship
Address
City State ZIP
Day Phone (
Evening Phone (
-
)
)
E-mail address
-
Academic Information
Present class standing (e.g., 1st-semester sophomore, etc.)
Major(s)
Minor(s)
Cumulative GPA
GPA in Major
I am not currently on academic probation.
I am not currently on disciplinary probation. Note: All records will be verified.
Page 5 of 7
Enrollment in CISI Insurance is mandatory for all Marquette University students who will be studying abroad
on academic programs or traveling overseas in conjunction with Marquette University academic coursework.
To extend your CISI coverage plan, you must submit this complete form to OIE in AMU 425. Please note
that CISI charges for your program are included in your program fee. If you choose to extend your coverage
pre or post program, your Bursar account will be billed $32 for each month of additional coverage.
Please Print
Program Name
Duration/Term
Name MUID
Date of Birth M
D/
Y/
Check one or both for optional coverage:
Up to only one month before program start date (for personal additional travel, pre-program activities, etc.)
Up to only one month after program start date (for personal additional travel, post-program activities, etc.)
All information provided on this form will be kept confidential, only to be reviewed by Marquette
employees or agents with a legitimate educational or safety need to know. Disclosure of the information
requested below is completely voluntary and will not be used to affect your eligibility to participate in a
study abroad program.
Please answer the following health questions completely and to the best of your knowledge. If you
answer yes to any of the questions, please supply details. You may attach a sheet if necessary.
1. Are you currently receiving, or have you received in the past two years, counseling for the treatment of
any emotional problem, drug addiction, alcoholism, psychiatric condition or eating disorder?
Yes
No
If yes
2. Do you have any significant chronic medical conditions requiring on-going medical supervision and
treatment, or have you had in the past any significant condition which is currently in remission (Ex.
Diabetes, heart problem, cancer, etc)?
Yes
No
If yes
3. Do you have any allergies (to medication, food, insects, etc.)
Yes
No
If yes
For Office Use Only
CISI Start: M_____D/_______Y/________ CISI End: M_________D/__________Y/__________
Total # of months: _______ Dollar amount posted to Bursar’s: $32 x # of months _________
= $ ____________________
Page 6 of 7
4. Are you currently taking any prescription medication?
Yes
No
If yes
*Note: If yes, it is likely you will need to bring an adequate supply of medications for the duration of the program.
5. Will you need a continuation of medical treatment while you are participating in study abroad?
Yes
No
If yes
6. Will you require assistance for any physical disabilities while you are participating in this study abroad
program?
Yes
No
If yes
7. Is there any additional information (concerning medical or mental health conditions or physical
disabilities that would be helpful for the program to be aware of during your study abroad experience?
Yes
No
If yes
DISCLAIMER: Marquette University is not responsible for monitoring medications, medical
conditions, or allergies.
Signature _
___
Date _
__
Page 7 of 7