Study Abroad Program Application

I. Personal Information
Last Name :
(Family)
First Name :
Middle :
Gender : Female     Male
Date of Birth :
(dd/mm/yyyy)
Place of Birth (city & state):
Country of Citizenship:
Passport Nbr :

Current Mailing Address
Street & number :
City & State:
Zip Code :
Country :
Other (not listed above):
Phone # :
Fax # :
Email :

Permanent Address (if different from above)
Street & number :
City & State:
Zip Code :
Country :
Other (not listed above):
Phone # :
Fax # :

II. Emergency Contact Information
Last Name :
First Name :
Relationship :
Street & number :
City & State:
Zip Code :
Country :
Other (not listed above):
Phone # :
Fax # :
Email :

III. Application and Academic Information
Academic year & semester
Current Academic Status : Freshman     Sophomore     Junior     Senior
Currently Attending :
Currently Cumulative GPA :
Major/Area of Study :
Due to limited space Oxford Module courses require early registration no later than April 15, 2009. In the event that you intend to register for one of the Oxford Module courses please indicate below:
Politics 399A Politics 399B

IV. Greek Language Experience (not required for acceptance into program)
Class Title :
# Terms :
Select one of the following : High School     College Level     Both
Proficiency in Greek (please check one level for each skill) :
Skill None Poor Fair Good Excelent
Speaking
Listening
Reading
Writing

V. Applicant's Statements
Why would you like to spend a semester/year at ACT? What are your expectations of this program?