Office of
International Affairs
STUDY ABROAD PROGRAM APPLICATION FORM
Delaware State University does not require you to have the highest grades to be eligible for study
abroad and most programs do not have language requirements.
Your individualism is as important as your academic record. Study abroad programs look for students
who are independent, self-assured, enjoy new experiences and different types of people, and can
handle challenges. When you study in a foreign country, you'll be faced with new circumstances,
environments, and predicaments.
You can begin learning about your study abroad program by looking at www.travel.state.gov , consulate
websites, country newspapers online, and travel books, such as Lonely Planet.
PLEASE COMPLETE THIS FORM NEATLY IN BLUE INK OR TYPESCRIPT.
PLEASE READ EACH DOCUMENT CAREFULLY AND RETURN THE COMPLETED APPLICATION
AND THE SUPPORTING MATERIALS TO MRS. CANDACE ALPHONSO-MOORE, GROSSLEY
HALL. If I am not in the office at the time when you drop off your application, please leave it with the
student assistants (room 115) or slide it under the door of room 115A.
INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED
Helpful Tips on Completing your Application:


Be sure to read Page 1 of the “Application Package!”
Be sure to read Page 3 carefully before signing the application!
(Program dates are subject to change)
DO NOT TURN THIS PAGE IN WITH YOUR APPLICATION IT IS FOR
YOUR RECORDS.
Study Abroad Application Form
Office of International Affairs – Grossley Hall 115
Male
NAME
Last
First
Female
M.I.
CURRENT ADDRESS
City
State
Telephone Number(s) (____)___________________________
Zip
Email________________________________
PERMANENT ADDRESS
City
State
Department
Zip
Major
Expect to Graduate (Month/Year)
D#
Current GPA
Faculty Advisor
(Name)
BIOGRAPHICAL
INFORMATION
Do you have a Passport? Yes___ No____
(Telephone)
If yes please list the passport number ___________________
When does is expire?______________________________
Date of Birth
Birth Place____________________________
mm/dd/yyyy
U.S. Citizen? Yes___ No ___
If no, do you have permanent resident status?
I-551 Card #
Other Citizenship (indicate country)
Yes No
Race (Optional – will not affect acceptance to the program) African-American Puerto Rican
Caucasian Latino/a Other Hispanic Native Pacific Islander Other_____________________
When do you plan to study abroad?
Fall Semester 20_____
Spring Semester 20____
Full Academic Year 20____ to 20____
How did you initially hear about study abroad at DSU?
Flyer
Professor Internet DSU Publication
Summer 20____
On-Campus Event
PLEASE READ AND SIGN THE BACKSIDE OF THIS APPLICATION
Friend
Other
SIGNATURE OF APPLICANT

I wish to be considered for Delaware State University’s Study Abroad Program.

To the best of my knowledge, the information contained in this form is complete and correct.

I attached a Letter of Recommendation and a Letter of Interest. (if applicable)

I accept the comments made by my department(s) concerning course choices. (if applicable)

I understand that the Study Abroad Program is competitive and I agree to accept the decision of the
Study Abroad Committee as final and without appeal.

If applicable, I agree to pay all relevant costs, subsistence, travel, tuition, during my participation in
the chosen Study Abroad Program.

I hereby fully release the use of my photograph(s) to Delaware State University. The photographs
may be used without restriction for the benefit of Delaware State University in any and all
publications and or on the web. I grant to Delaware State University all rights to use the
photograph(s) including, without limitation the right to print, publish, display publicly, distribute and
sell drawings or prints of the photograph(s) throughout the world and the exclusive right to license,
sell, distribute or otherwise dispose of the following rights in the photograph(s): publication and
sale of the photograph(s) in cards, posters, pictures, brochures, dramatic, motion picture, video,
dvd (sight and sound), broadcast (television) and electronic, mechanical or visual reproduction
rights (including intranet, internet, microfilm and computer) and International Studies materials; and
any and all future and other rights not specifically enumerated for the benefit of Delaware State
University. The above statement of release also covers the use of any quote and/or testimonial
given by me on the above date(s).

I affirm that I am 18 years of age or older at the time of signing this document.
Signed:_________________________________
Date:_________________________