Instructions:
1. Complete the top portion of the form.
2. Fill out courses to be taken at foreign institution portion if you already have an institution in mind.
3. You will be contacted by the Study Abroad advisor on your campus.
Study Abroad Advisors:
Greg Malveaux, Rockville Campus; • Sean Smith, Germantown Campus;
• Ijeoma Onwenu-Otigbuo, Takoma Park/silver Spring Campus
Students Name:______________________________________________________________________________ |
Last Name |
First Name |
Middle Initial |
Phone:_____________________Cell Phone:_____________________E-mail:_____________________________
Student’s Social Security Number: _________________________________________________
Student Signature: ______________________________Date:__________________
Semester for Study Abroad: _____________________________________________________
Overall Earned Credits at MC: ___________
Overall GPA (grade point average must be 2.5 or higher): _______
U.S. Host Institution: _____________________________________________________
Country: ________________________ Institution Abroad: ________________
Will you be applying for Financial Aid? ______ Yes _______No
Permission to enroll in another Institution
(Must be a full time student enrolled in 12 semester hours)
Courses to be taken at the Foreign Institution |
M.C. Equivalent |
1. ________________________________________________
|
__________________________ |
2. ________________________________________________
|
__________________________ |
3. ________________________________________________
|
__________________________ |
4. ________________________________________________
|
__________________________ |
5. ________________________________________________
|
__________________________ |
| Study Abroad Advisor Approval: ___________________________________________________________ |
Signature |
Date |
| Registrar (or Designee) Approval: ___________________________________________________________ |
|
Date |
| Cashier Fee Paid: __________ |
Date of Receipt: ______________ |
Cashier Receipt Number: __________
|
|
