SUMMER PSYCHOLOGY STUDY ABROAD PROGRAM
APPLICATION FORM:
2007
Name:___________________________________________________________
Address:
________________________________________________________________
________________________________________________________________________________________________________________________________
E-mail:
___________________________________________________(this is how I will
contact you)
Gender:
____ Male
____
Female
Phone:
(______)________________________
Date of
Birth: ____/____/____
UC Student
ID Number: ___________________________________________________
Current
Enrollment Status:
____ Freshman
____ Sophomore
____ Junior
____ Senior
____ Non-matriculated
____ Part-time matriculated
____ Graduate
Current overall GPA: ____________
College or university at which you
are currently enrolled: _______________________________
STATEMENT
OF AGREEMENT
I __________________________
[print your name] understand that participation in the 2007 RWC History of
Psychology Summer Study Abroad Program will require that I register for the course,
28
Psych 295 Study Abroad Psychology. I understand
that I will be required to carry all baggage that I choose to take with me, and
that I will share a dormitory style room with one or more same-gender classmates.
I also understand that I must be able to walk for several hours each day in
order to visit sites pertaining to the academic experience as well as walk to
our accommodations or public transportation.
I understand that during the course of this program I will be bound by
the University of Cincinnati Student Code of Conduct and that any violations of
that code will be subject to discipline and possible dismissal from the program
at the discretion of the program faculty.
I further verify that all information contained in this application
packet (including all attached forms) is true and accurate to the best of my
knowledge, and I understand that any misleading or
missing information in this package can result in my immediate dismissal from
the program, either at home or abroad.
__________________________________________
(signature)
Please
attach the following:
____ Brief statement (150-250 words, no more than
one-page) of why you wish to enroll in the program and what you hope to gain
from the experience.
____
Faculty Recommendation form with signature of your current or recent professor
____ Current transcript (only required for applicants
who are not current students of
____ Application fee of $150 (check to be made out to
($500
deposit due upon acceptance into the program)
Application deadline: February 1, 2007
Submit
completed application packet to:
Julie Yonker, Program Director
RWC Summer History of Psychology
Study Abroad
Applicants may be asked to come in
for an interview before the acceptance decision is made.
Applicants will be notified whether
they have been accepted into the program no later than March 1, 2007.
Faculty Recommendation Form
Please write a brief statement
concerning __________________________________ ‘s suitability for the History of
Psychology Study Abroad program.
Please give your recommendation and
additionally address the following issues:
The ability of this student to
abide by the UC Student Code of Conduct.
The ability of this student to get
along with and interact with others.
The ability of this student to
carry their baggage over long distances.
Faculty Signature
_________________________ Faculty
Contact Information _____________