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(This application can be easily downloaded. Click "Print Preview"
and "Print" pages 1-2.)
EDUSERVESM
GLOBALEARNSM
INTERNATIONAL EDUCATION PROGRAMS
Enrollment
APPLICATION
Checklist: Application__, Official Transcript/s*__,
Letter of Recommendation (if for credit)*__,
7 Photos (passport size) __, $75 Application
Fee__.
* Recommendation (if for credit), Official
Transcript/s, Passport Data (see below)
can
be supplied later, if necessary.
______________________________________________________________________________________________
GENERAL DATA:
_______________________________________________________________________________________________
Last Name .............................. First Name .................................. Middle Name
_______________________________________________________________________________________________
Permanent Address: Number & Street .................. City .................. State ... Zip Code ..... Nation
_______________________________________________________________________________________________
Current Address, if different from the above
_______________________________________________________________________________________________
E-Mail ..................................... Telephone/s: Day, Evening.................................. Fax
_______________________________________________________________________________________________
Miscellaneous Contact Information, if different
from above
_______________________________________________________________________________________________
PERSONAL DATA:
_______________________________________________________________________________________________
Date of Birth.................... Place of Birth................... Citizenship
_______________________________________________________________________________________________
Social Security No. ...... Valid Passport Number ....... Expiration Date ......... Nation
(If not available, passport information
can
be supplied later.) Click here for Passport details.
_______________________________________________________________________________________________
Gender M/F .......... Weight ................ Height ...................Eyes/Color
_______________________________________________________________________________________________
Health: generally excellent/good/fair/poor
........ Medications, if any
_______________________________________________________________________________________________
Any Medical Conditions/Operations/Illnesses
in the last three years? If so,
please describe.
EduServe/GlobaLearn International Education
Programs
Enrollment Application, page two
Applicant Name:
_______________________________________________________________________________________________
ACADEMIC DATA:
_______________________________________________________________________________________________
Most Recent Educational Institution: Name
..... City/State .... Degree/Grad .... Years
_______________________________________________________________________________________________
Major(s) ..................... Minor(s) .................... Cumulative Grade Point Average (4.0 scale)
_______________________________________________________________________________________________
Current Coursework, Goal, Plans, Year of
Study (Fresh/Soph/Jr/Sr/Grad
Student/Career)
_______________________________________________________________________________________________
Reason for pursuing study abroad (brief)
......................... Credit/Non-Credit?
_______________________________________________________________________________________________
Foreign Language/Level: Beginner,
High Beginner,
Intermediate, High Intermediate,
Advanced,
Fluent
_______________________________________________________________________________________________
Where, how, in what way have
you developed
your current language knowledge?
_______________________________________________________________________________________________
If seeking college credit, applicant must
send one letter of recommendation
from home
academic institution, indicating
that the
program applied to, if successfully
completed,
will receive credit. Details
with regard
to Academic Credit. If not seeking credit, please indicate
"not applicable" on
next line.
Name of College Administrator recommending
student for transfer of college
credit;
street address, e-mail address,
and telephone.
_______________________________________________________________________________________________
EduServe/GlobaLearn Program you have selected,
e.g., U.of _________, Semester,
Year.
_______________________________________________________________________________________________
Program fee to be paid by you __, parents
__, scholarship __, financial
aid __, other
____________.
Invoices shall be sent to you,
unless otherwise
indicated here. _________________________________
_______________________________________________________________________________________________
EMPLOYMENT DATA
Current Employment:
Will it be possible to arrange vacation or
leave of absence for study? Yes
__ No __.
_______________________________________________________________________________________________
REASON FOR YOUR STUDY ABROAD (more detailed):
_______________________________________________________________________________________________
I certify that all information that I have
supplied herein is true and correct
to the
best of my knowledge and belief.
I agree
to the terms and conditions for
participation
in EduServe/GlobaLearn International
Education
Programs.
Signature of Participant ________________________________________
Date:
Signature of Parent/Guardian ____________________________________
Date:
(if applicant is under 21 years of age)
Please mail to the following address: (1) completed
Enrollment Application; (2) if
student, official sealed Transcript/s of grades
from higher education institution/s; (3)
7 Photos (head & shoulders, passport
size), and (4) nonrefundable Application
Fee of $75.00. (Also required, if for credit, Letter of (academic or administrative)
Recommendation, stating that
if the program
is successfully completed that
credit will
be awarded.--This can be forwarded
later,
if necessary.)
EduServe/GlobaLearn Programs, Admissions,
P.O. Box 1000, New York, NY 10185,
USA.
Please e-mail GlobaLearn@EduServeInc.com to confirm mailing of application.
Please comply with Application Deadlines (please check
program details for specific
deadlines).
Please allow at least three days
within The
USA for mail to arrive at EduServe.
Please
mail First Class Mail or Air Mail only, not "certified" nor "return
receipt requested."
_______________________________________________________________________________________________
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