Complete and return to Dr. Skidmore-Hess

Name:
Street Address:
City, State, Zip:
Phone:
Email:

What is best way to contact you?

Major:

University or College affiliation and year (Sr., Jr., etc):

Provide the name and a way to contact an academic reference (ex. your advisor). This person may be contacted in regard to the potential educational benefit of this study-trip for you as well as your ability to adapt to diverse social contexts and environments:

Two more Important Questions:

1. Do you have a valid passport? What is the expiration date on your passport?

2. Do you have any health concerns or disabilities that might affect your capability to travel abroad, including a significant amount of walking and stair climbing? (If so, please indicate the nature of these concerns)

3. Relevant to the study part of the trip, which of the following courses are you interested in taking?
(may circle more than one)

a. POLS 3990/ECON 4100 a special topics course especially designed for this study trip
b. POLS 1150 - World Politics (Core Area B)
c. Independent study in Comparative Government
d. Other:
e. None of the above

A $200 non-refundable deposit must be made to AASU, accompanying this application. A payment plan for the balance of the trip cost is available.