please print or type clearly. personal information college ... · transcript as bint 3332...
TRANSCRIPT
First Name: _______________________________________
Last Name: _______________________________________
I identify my gender as:
male female ____________ (fill in the blank)
Citizenship(s): _____________________________________
Date of Birth: _____________________________________
Email Address: ____________________________________
Address: _________________________________________
Address Line 2: ____________________________________
Home phone: _____________________________________
Cell phone: ________________________________________
Personal Information College/University Information
Application Form 2020 SummerIntercultural Leadership Program in Strasbourg, FranceJuly 11 - August 9, 2020 Intercultural Communication and Sustainable Leadership
Please print or type clearly.
Student Signature: ______________________________________________________
Study Abroad Advisor - Signature: _______________________________________
Date:________________________________
Date:________________________________
University Name: __________________________________
Major: __________________________________________
Current cumulative GPA*: ___________________________
How did you hear about this program? _________________
________________________________________________
Transcripts:Please select your course prefix forIntercultural Communication SOCI 3332/BINT 3332
SOCI 3332 OR BINT 3332
Students should select which “prefix” (SOCI or BINT) best suits their major. Intercultural Communication SOCI/BINT 3332 is cross-referenced and has two course designators to permit business and non-business majors to receive appropriate credit toward their academic program. The class and course outline is identical for both prefixes. All students will take Sustainable Leadership (LDST 3340). There is no alternative course prefix for Sustainable Leadership and it will appear on their transcript as LDST 3340.
SOCI 3332 - (College of Humanities, Arts, & Social Sciences, Sociology Dept. ) will be listed on the transcript as SOCI 3332 Culturology and Cross-Cultural Communication
BINT 3332 (School of Business and Administration) will be listed on the transcript as BINT 3332 Culturology and Cross-Cultural Communication
LDST 3340: Sustainable Leadership (School of Professional Studies) will be listed on the transcript as LDST 3340 Sustainable Leadership
Transcripts will be issued by the University of the Incarnate Word.
Passport Information
Passport No.: __________________________________
Nationality: __________________________________
Date of issue: _________________________________
Expiration date: _______________________________
DAY / MONTH / YEAR
DAY / MONTH / YEAR
Please complete and return the signed application form per email to:CEPA Foundation c/o Eliana Rafael [email protected]
My Study Abroad Advisor: (Approval and signature of your study abroad advisor is required for acceptance into the program.)
First Name: ____________________________ Last Name: ________________________________________________
Email: ____________________________________ Phone: ________________________________________________
This is a credit bearing program. The student has been advised on the prefix required to select for their transcripts.
I do not currently have a passport, but will apply according to the directions on travel.state.gov
CITY STATE ZIP/POSTAL CODE
DAY / MONTH / YEAR