Summer Study Abroad: 2012 Application
Application Instructions: Save this form to your desktop. Complete all information, save a copy, and email the completed form to
Dana Pratt (firstname.lastname@example.org).
Last: Click here to enter text. Street Address: Click here to enter text.
Middle: Click here to enter text. City, State, Zip: Click here to enter text.
First: Click here to enter text. Date of Birth: Click here to enter a date.
Email: Click here to enter text. Gender: Click here to enter text.
Telephone: Click here to enter text.
Enrolled at College/University: Click here to enter Concentration/Major: Click here to enter text.
Graduation Year: Click here to enter text. ☐Undecided
Are you in good academic standing?* Choose an item. *Please note that all students will be required to submit proof
of academic standing following acceptance to the program.
Program Selection Choose an item.
Prior Experience Click here to enter text.
While there are no pre-requisites for these programs, students should list any
academic experience that is relevant to the course (i.e. language proficiency,
completed courses, personal interests, etc. ,
In 200 words or less, please provide information on why you are applying to this program: Click here to enter text.
Is there any additional information that should be considered when reviewing your application (i.e. prior coursework,
language proficiency, etc.). Click here to enter text.
How did you hear about this program? ☐Email/Online Newsletter
☐Study Abroad Advisor (Brown)
☐Study Abroad Advisor (Other Institution)
☐Faculty Member (Brown)
☐Faculty Member (Other Institution)
☐Other: Click here to enter text.
I understand that upon notification that I have been admitted to the program, I will be asked to submit a $300 deposit by a
certain date to confirm my participation. The deposit will be credited toward the total cost of the program.
I further understand that there may be minor adjustments to the program as it is described in online, but the general value of
the program and academic objectives will not change.
Receipt of credit for the completed courses is determined by the institution at which you are enrolled. Please check with your
institution to ensure that credit will be granted.
Please initial: Click here to enter text.
Admission decisions are made based on the applicant's academic records and his/her standing at the college where degree work is being
pursued. Other records or references in addition to the transcript may be requested. Applicants will be notified promptly of admission
Admission to the Summer Session is not in any way linked to admission to Brown or CASB for degree purposes. Students will be required
to work with their host institution to determine whether or not credit will transfer.
Return completed application to email@example.com by February 15.
STAFF USE ONLY
Date Received: Click here to enter a date. Missing Information? Click here to enter text.
Application Status? Click here to enter text. Language (if applicable): Click here to enter text.
Student notified: Click here to enter a date. Student ☐Accept ☐Decline
Click here to enter a date.