* City and Country of Birth
Home Institution
Please type the name of your home university
* Name of your home institution's exchange coordinator
* Email address of your home institution's exchange coordinator
Major
Please type your major/field of study at your home institution
* Area of Study
Please type the area of study/major you wish to take during your study abroad term
(i.e. business, engineering, biology, English language, humanities,etc)
List the courses that you would like to take while at USU:
All courses should be in a single line indicating:
Title of Course - Credits - Course # - Instructor
(For a description of courses offered, please go to http://www.usu.edu/ats/generalcatalog/. For a list of courses offered for the semester(s) that you plan to attend, please go to http://www.usu.edu/registrar/catalogpdf/ and pick the catalog for the semester that you are planning on attending.
* List the courses you have taken that would help prepare you for your program of Study Abroad at Utah State University
All courses should be on a single line indicating:
Title of Course - Credits - Grade - Semester/Year
* Emergency Contact Name
Person to contact in case of emergency (Parent, Spouse, Guardian preferred) to whom USU may release information regarding your Study Abroad participation before, during and after the program.
* Emergency Contact Relationship
How is your emergency contact related to you?
* Emergency Contact Street Address
* Emergency Contact Street City
* Emergency Contact Country
* Emergency Contact Phone (Day)
* Emergency Contact Phone (Evening)
If you answered yes to the "Special Medical Needs" question above, please describe needs
* Type your initials to indicate that you agree to purchase USU health insurance or show proof of adequate medical insurance upon arrival for the duration of your exchange
Your initials indicate that you understand that this insurance must meet the conditions outlined by U.S. Department of State. Failure to meet these requirements will result in your termination from the Exchange Visitor Program and my right to stay in the United States.
If you answered yes to the "lived/studied in another country" question above, please describe and include dates
* In the space below please include a one-page typed statement describing how this program will meet your academic and professional goals.
* Academic Referee Name
The completion of this application requires an academic references. Please provide the names and email addresses of persons who are willing to write an academic reference for you. Whoever you list as an academic referee will receive an automated request to complete an online recommendation.