APPLICATION FOR IUPUI STUDY ABROAD PROGRAMS

Note: Upon submission of this application you will be prompted to submit additional materials to support it. Applications are processed only upon receipt of all the requested materials.

Please make sure you have carefully read the program eligibility requirements before applying to a specific program and contact the Study Abroad Office if you have any questions.

This application is a program application only. This is not a scholarship application. Scholarship applications are separate from programs applications and have different application processes. Scholarship information and application requirements can be found at http://www.iupui.edu/~oia/SA/scholaid.html

LOCATION ABROAD

Select Program:

For all other programs, please apply directly through the department sponsoring the program. For information on applying to one of these programs, please see the Faculty Contact as listed in the program description.

To return to the program listings please click here.

 

PERSONAL INFORMATION

Name: (Last, First, Middle Init.)

IUPUI Student ID Number:(If you are not an IUPUI student please put "NA".)

Date of Birth: (You must be at least 18 years of age to apply.)
(mm/dd/yyyy)

Current Phone Number:

Current Address:
(Street, City, State, Zip)

Permanent Address (If different from above):
(Street, City, State, Zip)

Permanent Phone Number (If different from above):

Work Phone Number (If applicable):

E-mail Address:

Gender:
Male Female

Citizenship:
U.S. Citizen U.S. Permanent Resident
Other (Please indicate below)

Do you have a passport?:
Yes No

Ethnic Information (for statistical purposes only; response is optional).
Asian or Pacific Islander
Black (not of Hispanic origin)
Hispanic
Native American or Alaskan Native
White, not of Hispanic Origin
Other
I prefer not to answer

 

EMERGENCY CONTACT INFORMATION
This contact will be used in an emergency. Unless you contact Overseas Study and indicate otherwise, the emergency contact may also be sent informational materials about your program.

Name: (Last, First.)

Address: (Street, City, State, Zip)

Home Phone Number:

Work Phone Number: (If applicable)

E-Mail Address: (If applicable)

Relationship to applicant:

 

ACADEMIC INFORMATION

School Currently Enrolled:

If you selected the Other School option above, please indicate the name of your school in the box below:

Department Currently Enrolled:

Class Standing:
Freshman Sophomore Junior Senior Graduate DDS 1 DDS 2 DDS 3 DDS 4

Number of Credits Completed By End of Current Semester:

Overall G.P.A.:

Expected Date of Graduation: (mm/yyyy)

Major(s):

Minor(s):

Current Degree Program:
Associate Bachelor Master Ph.D. Non-Degree DDS

World Languages Credit:
This information is needed only if you are applying for a program which requires a foreign language background.
French Japanese Spanish

Please list the number of semesters you have earned credit for in the language selected above. If you are fluent in the language but have not had any education, please state this:

 

PRIOR EXPERIENCE ABROAD

Have you studied, worked or traveled abroad? If yes, please give a brief account of your experience. If none, please type "none".

 

PROGRAM PARTICIPATION
Please note: All students participating in IUPUI Study abroad programs are required to have health insurance which includes medical evacuation and repatriation benefits. Upon acceptance into this program you will be given information on the health insurance required for the program.

 

CERTIFICATION - REQUIRED

I certify that the preceding statements are correct and true.

By clicking the submit button, you agree to the above statement, and certify that all information, to the best of your knowledge, is accurate.

This online application does not constitute a complete application packet. A list of further requirements will be provided to you upon submission of this form. Further requirements may include, but are not limited to, Agreement and Release forms, recommendation letters and personal essays. Please follow the directions on the following screen and/or contact the Study Abroad Office for further assistance. Your application will not be considered unless the application packet is completed in full.

 

For more information, contact
The Director of Study Abroad, Indiana University-Purdue University Indianapolis
902 W. New York Street, Indianapolis, IN 46202
Tele (317) 274-2081, Fax (317) 278-2213, E-mail: abroad@iupui.edu