Summer Short Term Study Abroad Application

Personal Information

First name

Last name

FPU student ID

Birthdate

Address while at school

Home address

Email address

Cell Phone/local number

Do you have any health concerns that the trip organizers should be aware of (special medications, mental health, travel issues, etc.)?

Yes

If yes, please describe (this information will be kept confidential)

Additional questions or comments

Have two faculty or staff persons use this form to evaluate your potential for a study abroad program. Alternatively, print out this evaluation form and give it to two faculty or staff to complete.

Note: All students who participate in a Fresno Pacific Summer Study Abroad trip must be in good academic and financial standing with the university prior to departure.