Study Abroad Interest Form

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Student ID #:

First Name:

Middle:

Last Name:

Email Address:

Telephone:

Major:

Minor:

Current GPA:

Academic Level:

Number of Earned Credits:

Expected Graduation Date:

Where would you like to study abroad?:

What semester would you like to study abroad?:

CONTACT INFORMATION:
Rusty Wienk
Program Coordinator
Office of International Studies

Black Hills State University
1200 University Street
Unit 9519
Spearfish SD 57799-9519
Rusty.Wienk@BHSU.edu

605.642.6942