Application to Participate in Study Abroad (Current BHSU Students)

Please indicate to which program you are applying:

Please specify the year to which you are applying:

Please specify the term to which you are applying:

FallSpringSummer

Full Name (First, Middle, Last)

Preferred Name

Date of Birth

Gender:

Current Address:

City

US State

ZIP Code

Home/Permanent Address (if different from current address)

Home/Permanent City

Home/Permanent US State

ZIP Code

Emergency Contact #1

Full Name

Relationship

Phone Number

Emergency Contact #2

Full Name

Relationship

Phone Number

What is/are your current major/majors?

What is/are your current minor/minors?

How many credits have you completed at BHSU?

Are you expecting to graduate prior to studying abroad, or immediately following your program abroad?

YesNo

What is your current cumulative GPA?

You must read and agree to the Acceptance, Release and Waiver Statement document; by selecting 'I agree', you acknowledge that you have read and understand the contents of the document.

I agree

By entering my name below, I confirm that I have read, understand, and assumed the risks associated with studying abroad, and agree to hold harmless Black Hills State University, the South Dakota Board of Regents, the State of South Dakota, and their staff, officers, and program director(s).

Signature

By submitting this form, I acknowledge that the information on this application is true and correct to the best of my knowledge.