Summer Study Abroad - DOC by z0Ze2Va

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									BARRETT, THE HONORS COLLEGE
SUMMER STUDY ABROAD SCHOLARSHIP
APPLICATION 2012 – 2013

PERSONAL INFORMATION (Please type all information)
Last, First, Middle                                   ASU Affiliate Numbers (100…):          AZ Resident: Yes       No
Name:


Local Address (include apartment number if            City, State, Zip:                      Local Phone (include area code):
applicable):

Email Address:                                        Class Year (Anticipated graduation year):



OPTIONAL INFORMATION
   American Indian or Alaskan Native               Asian American or Pacific Islander               African American

   Hispanic                     White, not Hispanic                       Forward without comment

United States Citizen           Yes                No

First generation attending a college or university?                       Yes              No



ACADEMIC INFORMATION (Please type all information)
Major 1:                                                                    Overall GPA:
Major 2:
Minor/Certificate:

EMPLOYMENT INFORMATION
(Please include a current resume detailing internships, work experiences, educational accomplishments and leadership positions)
Are you currently employed?        Yes                        No                If Yes, where?

# of Hours per Week:       Less than 20            20 hours               21 – 40 hours    40 or more hours



SUMMER STUDY ABROAD INFORMATION

In which Barrett Summer Study Abroad Program do you plan to enroll?

Have you been on a study abroad trip before?

Have you been to any other countries?
If it is pertinent, please describe any unusual personal expenses or income situations that make it difficult for you and your family to
contribute to the cost of your education.




     2        BARRETT, THE HONORS COLLEGE
              SUMMER STUDY ABROAD APPLICATION 2012-2013
BUDGET FORM 2012 – 2013
Complete the following budget for 2012-2013. Figures should reflect expected expenses and income for the nine month academic
year plus expenses and income received during the summer starting in August 2012 to the end of July 2013.

EXPENSES

      Tuition & Fees
               Tuition & fees                              $
               Books & supplies                            $
      Transportation
               Car Payments                                $
               Insurance                                   $
               Other Transportation                        $
      Room & Board
               Rent (Res Hall or Apt/House)                $
               Food                                        $
               Utilities                                   $
               Telephone                                   $
      Personal Expenses
               Clothing                                    $
               Laundry                                     $
               Health Insurance                            $
               Other Insurance                             $
               Recreational                                $
               Organizational dues                         $
TOTAL EXPENSES                                                                       $

INCOME
            Student Loans                                  $
            Grants (Pell, SSIG, SEOG)                      $
            Grants (university)                            $
            Summer Savings                                 $
            Semester Earnings                              $
            Parental Support                               $
            Scholarships received
            1.                                             $
            2.                                             $
            3.                                             $
            4.                                             $
            5.                                             $
            Federal Benefits (if any)
                     GI Bill                               $
                     Social Security                       $
TOTAL RESOURCES                                                                      $

                                                        BALANCE SHEET
                                                 Total Expenses:        $
                                                 Minus Total Resources: $
                                                 =Unmet Financial Need $




    3        BARRETT, THE HONORS COLLEGE
             SUMMER STUDY ABROAD APPLICATION 2012-2013
                          CONSENT TO RELEASE RECORDS & TERMS OF AGREEMENT

The federal Family Education Rights and Privacy Act (FERPA) protects the privacy of education records that the
university maintains about me. By signing below, I give permission for ASU and Barrett, The Honors College to disclose
to the donor and any review committee the information provided in connection with this scholarship application for the
purpose of the review of my application, and the administration and promotion of this scholarship program. This may
include information from my educational records, such as my official transcript, and financial aid information.

I understand that if any application information that I provide or that is provided on my behalf is false, misleading or
incomplete, I will not be eligible for any scholarship award, and that any scholarship awarded to me will be revoked and I
will need to return any amounts paid to me. The university and donor may also pursue appropriate legal action as well as
administrative actions under the Student Code of Conduct.




________________________________________________________                         _____________________________
Signature                                                                        Date




CHECKLIST: Please check all the items you have included in your application envelope.           Incomplete applications
will not be considered:

  Transcript (official or unofficial)

  Resume

  Application Form


SUBMIT ALL ITEMS IN A LARGE ENVELOPE TO BARRETT, THE HONORS COLLEGE, SAGE
NORTH 102 (PO Box 871612, ASU, Tempe, AZ 85287-1612). COMPLETED APPLICATIONS MUST BE
RECEIVED NO LATER THAN OCTOBER 19, 2012.




    4       BARRETT, THE HONORS COLLEGE
            SUMMER STUDY ABROAD APPLICATION 2012-2013
OFFICE USE ONLY

ASU GPA:
ASU Hours Completed:
Honors Credits Completed:
Date Application Received:
Unmet Financial Need $




Class Standing:
Notes:




   5     BARRETT, THE HONORS COLLEGE
         SUMMER STUDY ABROAD APPLICATION 2012-2013

								
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