Student Information Form for Study Abroad

Name
Your e-mail
Phone
Campus box
Majors
Minors
Parent name
Parent phone
Parent address
Health insurance
Preferred Language of instruction while abroad
Current or most recent language course taken at Carthage

(language, number, and term)
Country (or countries) under consideration
University/School Program abroad

(if known)
Field of study while abroad

(specific coursework desired, if any)
Year/Term of anticipated Study Abroad
Current year in college
Previous international travel or study abroad experience
- Yes
- No
If yes, where?
Do you have a current passport?
- Yes
- No
Expiration Date

(mm/yy)
Preferred housing arrangements

(Typically, we encourage our students to participate in the host family experience)