Application for Study Abroad
Part III
Saratov State University
Russia
Questionnaire (Please type or print clearly)
1).
Have you previously traveled outside the U.S. or Canada? Yes _____ No _____
If yes, where and for how long?
2).
Have you previously been to Russia? Yes _____ No _____
If yes, for how long and in what capacity?
3).
Do you have any relatives in Russia? Yes _____ No _____
Any friends? Yes _____ No _____
4).
Are you married? Yes _____ No _____
5).
Do you have any children? Yes _____ No _____
6).
Do you currently live with your parents? Yes _____ No _____
7).
Which, if any, Russian language courses will you have completed before the exchange begins?
Please list specific course numbers. When was the most recent course completed?
8).
Which other languages, if any, do you know?
9).
Are you afraid of flying? Yes _____ No _____
10). Do you have any special dietary requirements? Yes _____ No _____
Are you a vegetarian? Yes _____ No _____
Please list any dietary limitations, restrictions, etc., which you may have to observe.
11). Do you have any special medical needs, physical impairments, or chronic conditions which may be
difficult to address in a foreign country? Please be specific.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
12). Please write your birthdate:
(mm/dd/yyyy) _______/______/_______________
13). What will be your age at the start of the exchange? __________
14). Do you have any allergies? Yes _____ No _____
If yes, please specify.
15). Do you tire or become fatigued easily? Yes _____ No _____
16). Can you swim? Yes___
No ___
17). Would you consider yourself an adaptable person? Yes _____ No _____
18). While in Russia you will no doubt be presented with many new and unfamiliar foods.
Do you consider yourself adventurous enough to experience new dishes so as not, for example, to
offend a kitchen-weary host? Yes _____ No _____
19). Are you prepared to adopt a new diet for a period of several weeks, a diet that will likely be less
preservative-filled and more natural than the typical American diet, but which will nevertheless
also be somewhat unfamiliar? Yes _____ No _____
20). While in Russia you may be asked by Russian friends, family, etc., for your open and candid
impressions on a wide variety of subjects. Do you feel able to frankly state such impressions,
either positive or negative? Yes _____ No _____
21). You will probably live with a Russian family for an extended period in Saratov. At times you
will undoubtedly find living with a new family to be very demanding. Do you feel up to this
challenge? Yes _____ No _____
22). After the exchange, do you plan to continue study of the Russian language? Yes _____ No _____
23). After the exchange, would you (if a student enrolled on the UW campus) be willing to participate
in meetings or activities designed to organize and improve future exchanges?
Yes _____ No _____
24). Do you plan to do any traveling within or outside of Russia immediately before or after the Saratov
University program? Yes _____ No _____ If yes, please specify.
25). Do you have a U.S. passport? Yes _____ No _____
If yes, when does it expire? MM ____________ DD ____________ YR ____________
If no, can you obtain a copy of your birth certificate? Yes _____ No _____
(In some cases this may not be the birth certificate you’ve probably seen framed in your home, but
rather the official, legal document from the state where you were born.)