Canisius College Study Abroad Application

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1 APPLICATION CHECKLIST Please complete this application by typing your responses in the online form only. Once completed, please print the application and return it, along with the following documents, to the Canisius College Study Abroad Office located in Frisch 005 prior to the application deadline, February 2, 2015 for the Fall 2015 semester and March 2, 2015 for the Spring 2016 semester. *Please note: all accepted students will be required to attend a Study Abroad Orientation. The date of the orientation for Fall 2015 applicants is February 24, 2015 from 5:15-7:30pm. The date of the orientation for Spring 2016 applicants is April 23, 2015 from 5:30-7:00pm. This orientation is mandatory for all students and cannot be rescheduled. Items to be submitted by student: Completed Canisius College Study Abroad Application Student Study Abroad Statement Request 2 Academic Faculty References (completed and submitted online by faculty members) Official transcript for courses taken at other institutions (the Study Abroad office will request your Canisius transcript). Advisement Meeting Form, signed by a Study Abroad Adviser. You must meet with an adviser prior to submitting your application to discuss program selection, available courses, finances, and other concerns that are best addressed before applying. To make an appointment, or stop by Frisch 005. Updated and Accurate GriffAudit: In order to run and print a GriffAudit please go to Please make sure it includes your correct majors, minors, and concentrations and is identical to the majors, minors, and concentration you list on your study abroad application. Also, please make sure that all fulfilled and in-progress classes are on your audit for the correct requirements. If this information on your GriffAudit is not correct nor does not match your application, you cannot be evaluated for acceptance to study abroad until you have this information corrected by the Office of Student Records. [The audit will allow you and the committee to determine your remaining degree requirements and your ability to take appropriate courses while studying abroad.] Week at a Glance Schedule Outline of Remaining Courses (See example on page two): Please indicate what types of classes you are planning to take during your semester abroad (such as major, minor, core, free electives, ect.). Since next semester s course schedules abroad are not yet available, you will not be able to list the names of specific courses (see example of study abroad semester on next page). Please also map out the courses you wish to take during your remaining semesters at Canisius to indicate how you plan on completing all your major, minor, core, and program (i.e. Honors Program) requirements. Your sample outline will give you a better idea of where the classes you plan on taking abroad will fit into your degree pursuit. Your sample outline is just a sample and therefore may be different from the actual courses you will take in future semesters including your semester abroad. Please refer to your GriffAudit when looking into remaining core, major, minor, and program requirements. 1

2 Once you are accepted, you will meet with your Associate/Assistant Dean and Department Chair for approval of which classes you can take while abroad. For more information on classes offered abroad, please meet with a member of the Office of Study Abroad. Major: Biology Minor: Psychology Program: Florence, Italy Example of Outline of Remaining Courses Spring 2015 (semester abroad) Elementary Italian (Free Elective) Free Elective History- Field 4 Arts- Field 3 Fall 2016 MAT 111 (Mathematical Sciences- Field 7) RST 314 (Religion- Field 1) Spring 2017 BIO 353 Seminar II (Major) BIO 477: Core Capstone (Major) 2

3 Application Information Name: Last First Middle Canisius Study Abroad Program: Country City Program/University If you would like to be considered for a second program, please list the program below: Country City Program/University Term of Study for which you are applying: (check the box and include the year next to the appropriate term, e.g. Fall 15) Fall Spring Summer Other How did you learn about this program? Personal Information Date of Birth: / / Place of Birth: Gender: Male Female Mo Day Year City / State Country Citizenship: Visa Status (if not US citizen): Canisius Student ID #: Social Security #: My local/campus address can be used until: / / Mo Day Year Would you like to receive information via text? Yes No Local/Campus Mailing Address: Permanent/Home Address: (if different) Street Address Apt # Street Address Apt # City State Zip Code City/State Country (if not US) Zip/Postal Code Cell Phone: ( ) Campus Permanent/Home Telephone: ( ) Alternate Please notify us of any changes in your contact information. Academic Information Academic Information Current Standing: Freshman Sophomore Junior Senior Master Other Major(s): Minor(s): Academic Advisor: GPA: Major Cumulative Expected date of graduation: Degree Credits: Completed Currently Enrolled 3

4 Please list below any other colleges or universities you have attended. Name of Institution Dates of Attendance Credits Degrees/Certificates Received Contact Information Emergency Contact Information Person to contact in case of emergency: Name Relationship to you Street Address Apt Number City/State Country (if not US) Zip/Postal Code ( ) ( ) Home Phone Cell Phone Parent or Guardian (if under 21): Parent or Guardian (if under 21): Name Relationship to you Name Relationship to you Street Address Apt Number Street Address Apt Number City/State Country (if not US) Zip/Postal Code City/State Country (if not US) Zip/Postal Code ( ) ( ) ( ) ( ) Home Phone Cell Phone Home Phone Cell Phone Financial Information Student Declaration Academic Faculty References Please provide the name and title of two faculty members who will complete an academic reference on your behalf. References are completed online. Provide your selected faculty members with the following link: You must select faculty who have or have had you as a student. If you are studying in Dortmund, Eichstaett, Lille, Oviedo, Comillas, Peru, or El Salvador, you need a reference from a language professor. Academic Reference #1 Academic Reference #2 Name Title Name Title 4

5 Student Study Abroad Statement Please write a Student Study Abroad Statement in essay format. It should be typed on separate pages and attached to this form. The minimum length is one typed page. Your Student Study Abroad Statement should include: When you engage in a study abroad program, you participate in experiences which enrich your own life while simultaneously serving as a representative of Canisius College and the United States. How will you respond to this challenge and what will you do to serve as a positive representative? What are the academic and personal goals you expect to reach from the study abroad program? What challenges do you expect to face as you achieve both goals? Why did you choose your specific study abroad program? Please be aware that the Study Abroad Selection Committee will consider the quality and the content of your essay in making a decision about your eligibility for study abroad. This essay is required of all applicants and must be submitted with the application. Additional Information 1. List any extracurricular activities or organizations that you have been involved in at Canisius. Please list dates and any leadership positions held. 2. Please list any work experience that you ve held while a college student. Please list where you worked, job title, how many hours per week, and dates of employment. 3. Have you ever been involved in any disciplinary situations in the past at Canisius or any other college or university? If so, please explain: 4. Do you have any medical, physical or psychological problems that would restrict any active participation in study or travel? If yes, please note below. I certify that all information on this application form is true to the best of my knowledge. Student's Signature Date 5

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