Application NYC 2011

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Application NYC 2011 Powered By Docstoc
					                           College of Arts and Letters
                          MICHIGAN STATE UNIVERSITY
APPLICATION: available at www.msu.edu/~devossda/nyc; please complete this form in Microsoft Word,
print it, and sign at the end before submitting it. If you must handwrite this form, please write clearly.



PART 1
BASIC AND CONTACT INFO


Name:                                                                                   Sex:    Male   Female
           (Last)                            (First)

MSU PID:                                                       Email:


Citzenship:                                                                    Date of birth:


Current
Address:                                                                             Phone:
              (Street Address)                 (City, State, Zip)




In case of emergency, notify:                                                Relationship to you:

Emergency contact
address:                                                                              Phone:
                          (Street Address)              (City, State, Zip)


Alternate emergency contact:                                                   Phone:
PART 2
ACADEMIC INFO

Major:                                                               Academic advisor:

Current GPA:                             Expected semester of graduation:

Have you discussed your plan to participate in this program with your academic advisor?            Yes     No

Have you ever been disciplined for academic misconduct or misconduct in university housing? Yes            No

Which classes do you intend to take as a participant in this program? (minimum is 8 credits)

                AL 491: Art, Culture, and NYC (special topics, 2 credits, required for all participants)
                WRA 491 Special Topics: WriteNYC (3 credits)
                WRA 308: Invention in Writing (3 credits)
                AL/WRA 490: Independent Study (3 credits)

Do you plan to use Financial Aid for this program?       Yes        No



PART 3
REFERENCES INFO

Please provide the names and contact information for two personal references, such as professors,
teachers, or former employers; do NOT list classmates or relatives.

Full Name:                                                                   Email:

Address:                                                                     Phone:

For how long and in what capacity
do you know this individual?


Full Name:                                                                   Email:

Address:                                                                     Phone:

For how long and in what capacity
do you know this individual?




NYC Study Away 2011 Application                                                                            2
PART 4
ESSAY

Please attach an essay of 300 words or less (approximately one double-spaced page) addressing the
following question: How do you imagine that your MSU education will be enhanced by the Study
Away program in New York City?




PART 5
APPLICATION FEE

Space in this program is limited. All applications must be accompanied by a $100 application fee in
the form of a check or money order made out to “Michigan State University.” This fee cannot be
billed to your student account. If you are not admitted to the program, the fee will be refunded. If
you are admitted to the program, this $100 application fee will be applied to your program fee.




SUBMISSION
APPLICATION SUBMISSION

The completed application form, essay, and application fee should be submitted as soon as possible,
and no later than January 14, 2011, to:

                        Dr. Sarah B. Fryer, Director of Student Affairs and Advising
                        College of Arts and Letters
                        Michigan State University
                        200 Linton Hall
                        East Lansing, MI 48824

Questions can be directed to Dr. Fryer via e-mail (fryer@msu.edu) or phone (517-355-0366).

I certify that the information provided here is correct.




Signature: _____________________________________________ Date:____________________




NYC Study Away 2011 Application                                                                   3

				
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