Tanzania Application

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Summer Study Abroad Tanzania Application

Demographic Information

First Name*

Middle Name

Last Name*

T-Number*

Preferred Phone Number (Home/Cell)*

Current Address

Street Address*

City*

State / Province / Region*

Zip / Postal Code*

Permanent Address

Street Address*

City*

State / Province / Region*

Zip / Postal Code*

Academic Information

University or College Currently Enrolled*

Hours Complete or Status*

Major / Minor*

Emergency Contact

Name*

Relationship*

Phone Number (Home/Cell)*

Street Address*

City*

State / Province / Region*

Zip / Postal Code*

Please Answer The Following Questions

DO YOU HAVE SPECIAL DIETARY NEEDS VEGETARIAN, NON-DAIRY, DIABETIC, ETC?

DO YOU HAVE ANY MEDICAL CONDITIONS THE PROGRAM SHOULD BE AWARE OF (PSYCHOLOGICAL OR PHYSICAL)?*

DO YOU HAVE ANY SPECIAL NEEDS THAT MAKES IT DIFFICULT TO WALK LONG DISTANCES TO CLIMB STAIRS?*

WHAT IS YOUR PREVIOUS EXPERIENCE ABROAD?*

WHAT DO YOU HOPE TO EXPERIENCE AS PART OF YOUR STUDY ABROAD PROGRAM?*

HOW DO YOU THINK A SUMMER ABROAD EXPERIENCE WILL HELP YOU ACHIEVE YOUR LIFE GOALS?*

Applicant Signature*Enter your name/signature

Date*Today's date