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Please complete and print this application using your web browser. The application must be TYPED. Sign this form with your advisor and submit to the Career Center with the documentation listed below. Incomplete applications will not be accepted.

Study Abroad Application

Study Abroad Program to which you are applying: First Choice

University City

Country
Indicate proposed length of Study Year
Fall Semester (August - December)
Spring Semester (January - May)
Summer Semester

Study Abroad Program to which you are applying: Second Choice

University City

Country
Indicate proposed length of Study Year
Fall Semester (August - December)
Spring Semester (January - May)
Summer Semester

Study Abroad Program to which you are applying: Third Choice

University City

Country
Indicate proposed length of Study Year
Fall Semester (August - December)
Spring Semester (January - May)
Summer Semester
 
Personal Information 
Salutation
Mr. Ms.  
Last Name First Name and Middle Initial
(M.I.)
Student Number  
 
E-mail Address Date of Birth DD/MM/YYYY
Citizenship Visa Status (if non-US)
Local Address  
Line 1
Line 2
Line 3 		 
Telephone (with area code) Date Effective Until
Permanent Address  
Line 1
Line 2
Line 3 		 
Telephone (with area code)  
 
 
Emergency Information
Contact in case of an emergency Relationship
Emergency Address  
Line 1
Line 2
Line 3 		 
Telephone (with area code) Business Phone
Other Emergency Contact Telephone (with area code)
 
Academic Information
Academic Advisor
Academic Major Year
1st 2nd 3rd 4th
Present Cumulative Grade Point Average
GPA in your major
Number of credits you will have prior to studying abroad
Courses in which you are currently enrolled and any other courses to be completed prior to your study abroad (Include course name)
List the courses you would normally take at Clarkson during the semester you plan to study abroad (Include course name)
Indicate what foreign languages you have studied (in college or high-school) or which languages you speak fluently
 
Background Information 
List any campus or community activities in which you are involved
Previous overseas travel
List foreign languages you speak
Do you have any physical challenges or allergies? Do you have any learning disabilities?
   
How do you anticipate meeting the cost of this program? (check applicable means) Parental Support Tuition Remission
Personal Funds Financial Aid
Other (Please specify)

Applications must include the following: 

 

1. Completed Application Form (TYPED)

 

2. Essay  -  Explain (in approximately 300 words) why you want to participate in the Study Abroad Exchange Program.  Please identify how this experience will impact your life academically, professionally, and personally.  Please address this generically as opposed to directing to a specific country or school.

3. Resume

4. 2 Recommendation Letters – must have 2 individuals (at least 1 from Clarkson) familiar with your academic work write you a recommendation     letter.  Please have them address these generically as opposed to directing to a specific country or school.

5. Completed Academic Compatibility Form.

6.  Completed Student Participation Form.

 

7.  Proof of Passport or evidence of application of a passport.

 

8.  Unofficial Transcript (from PeopleSoft)

 

I certify that all information submitted on this application is true to the best of my knowledge. (Applicant please sign below)

Sign:______________________________________________ Date:____________

I have discussed and approved of the proposed study abroad program with the student. (Faculty advisor please sign and print name below)

Sign:______________________________________________ Date:____________

Please send completed application and supporting materials to:

Career Center
International Study Program
ERC, Box 5620
Clarkson University
Potsdam, New York 13699-5620

Telephone: (315) 268-6477
Fax Number: (315) 268-7616