Revised, 1/23/12
Application for England & Belgium Study Tour – June 1-10, 2012
Please complete the following application to participate in the study tour to England and Belgium.
The information you provide will help in the selection of participants and will be held in strict
confidence. Send the completed, typed application to Dr. Bryan Duke at bduke@uco.edu or deliver
to CTL, 214. If you have any questions, contact him at 405-974-5529. Thank you.
Name (as it appears on your passport) ____________________________________________
If you do not currently have a passport, please check this box. □ You are still eligible to apply.
Date of Birth
Passport #
Email(s) ________________________________________
Mobile Phone ___________________________ Home Phone
UCO ID # *
Major ___________________________________
Classification (Fresh, Soph, Junior, Senior, Grad) ___________________GPA ______________________
1.
Have you ever been out of the United States? If so, where, when, and what did you do/see while there?
2. On the trip, we will likely utilize the following vehicles for transportation. Do you have any problems or
concerns with traveling this way? If so, please explain.
Airplane
Bus
Train
Feet
3. We will be engaged in physical activities, including a great deal of walking, during our time in Europe. In
order to keep the pace of our travel, students will be required to walk quickly and to navigate the busy
city of London. Additionally, London and most of our European sites have uneven walkways, steep stairs,
etc. Do you have any medical or physical issues that would impede your participation in physical activities
or efficient walking? If so, please explain.
4. What do you hope to learn as a result of your experience on this study tour?
5. As a member of the study tour cohort, what assets, skills, and contributions can you bring to the group
travel experience? In other words, describe your ability to work well with and to travel well with others.
6. Describe your plans for your academic and/or professional future.