GUATEMALA SUMMER SPANISH IMMERSION PROGRAM
May 12 – June 07, 2013
CHECK LIST AND STUDENT DATA SHEET
DEADLINE: March 1, 2013
(Early applications are most welcome: Limit is 20 students)
( ) This Student Data Sheet – must be completed and turned in with essay and transcript
( ) Unofficial Transcript – obtain from Registrar’s Office or on-line.
( ) Personal Statement Essay – write a short essay (1-2 double-spaced, typed pages) explaining why
you would like to participate in a program in Guatemala and how well you believe you will adapt
to immersion in another culture and language.
( ) Faculty recommendation form – must be returned with above information
( ) Deposit: $500 check made out to University of the Pacific must be attached to your application.
This payment will be deducted from the total cost of $1975 due 4/1/12.
Please note: This deposit is non-refundable once you are accepted for the program.
Local Phone: _______________________________ ID#__________________________________
Local Address: ________________________________________________________________________
(Street Address) (City) (State) (Zip)
Female ( ) Male ( ) Date of Birth: ____________ Email Address: ______________________
School/College: _______________________________ Year: F S JR SR
(COP, SIS, BSE, ESB, etc.)
Major: ____________________________________ Advisor: ______________________
Anticipated Spanish level in Guatemala (circle one) : 11a 11b 23 25 27 101 193 DON’T KNOW
Parents’ Name: ________________________________________________________________
Permanent Address: ____________________________________________________________
Permanent Phone Number: _______________________________________________________
Would you also be interested in this program if it were offered in the summer session III ?
Would you like to be considered for a scholarship (based on gpa and quality of essay)
How did you hear about the program: ( )fair ( )e-news ( )friends ( )faculty ( )_____________________
Please return to Modern Language and Literature Office in the Hub of WPC Annex.
Or mail to: Prof. Katie Golsan, Modern Language and Literature, University of Pacific,
3601 Pacific Ave, Stockton, CA 95211.