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Keystone Study Away
Write your study abroad essay FIRST.
Save it in your computer and have it available to download at the end of this application.
How to write The Essay
Declaration of Intent to Study Abroad
Eagles Abroad Programs
Country You Are Going To Study In:
Program(s) You Are Applying For
Duration:
Year
Fall
Spring
Summer
General Information
:
Student ID Number:
Last Name:
First Name:
Middle Name:
Preferred Name:
JC Address
JC Box:
Permanent Address
Street Address:
City:
State:
Zip:
Phone:
Cell Phone:
E-mail:
Gender:
Male
Female
Date of Birth:
Month:
January
February
March
April
May
June
July
August
September
October
November
December
Day:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
(yyyy)
:
Are you a US Citizen:
Yes
No
If No, Citizenship:
Place of Birth
(city, state, country)
:
Do You have a Passport?:
Yes
(you will be asked to submit copy of front page to cie)
No
(you should apply for your passport asap; see director of study abroad for assistance)
Father/Guardian Information
:
Full Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
E-mail:
Occupation:
Mother/Guardian Information
:
Full Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
E-mail:
Occupation:
Academic Information
:
POE:
2nd POE (optional):
Current GPA:
Academic Faculty Advisor:
General Faculty Advisor:
Department Chair:
General Health Information
:
Describe Any Health Conditions You Have:
Do You Take Any Prescribed Medication:
Yes
No
If Yes, What and for What Condition:
Do You Have Any Special Needs or Do You Require Any Special Accommodations? Please Describe:
Do You Have Any Dietary Restrictions, Any Allergies; Are You a Vegetarian, etc:
Name of Your Health & Accident Insurance Policy:
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