UW-Platteville Study Abroad Application                 

Last Name:

First Name:

Middle:

Social Security Number:

E-Mail:

Gender:

Date of Birth:

Racial Ethnic Heritage (Optional):

Are you a US Citizen?

Country of Citizenship:

If no, select one below:

Address:

City:

State:

Zip Code:

Country:

 Phone:

Current Mailing Address

Address:

(if different from Permanent Address)

City:

State:

Zip Code:

Country:

Phone:

Valid From:

-Select One- London, England Suva, Fiji Seville, Spain Nagasaki, Japan Rome, Italy Wuhan, China Newcastle, Australia

Fall only

Spring only       

Name, City, State:

Graduation Date:

In lieu of a high school diploma have you completed one of the following?

Issued by State of:

Test Date:

College/University:

From:

To:

Cumulative G.P.A.:

1st Major:

2nd Major/Minor:

Minor:

How did you hear about the program?
(select all that apply)

College, Univ. or Voc.-Tech Schools
(Name, City and Dates Attended)
 

Parent/Guardian:

Is he living? 

Name:

Current Address:

 Since:

Home Phone:

Business Phone:

Previous Address:

 Since:

Has he filed a Wisconsin state income tax return as a resident within the past two years?

U.S. Citizen?

Where and when did he last vote or register to vote?

Parent/Guardian:

Is she living? 

Name:

Current Address:

 Since:

Home Phone:

Business Phone:

Previous Address:

 Since:

Has she filed a Wisconsin state income tax return as a resident within the past two years?

Is she a U.S. Citizen?

Where and when did she last vote or register to vote?

(B) Have you, your spouse or parents recently moved to Wisconsin to begin full-time employment, or do you expect to do so before the beginning of the term for which you are applying? 

I have claimed my own exemption:

List former addresses, if any, during the last two years:
(Include Address, City, State, Zip and Dates)

Statement of Purpose

Please indicate below in a few paragraphs your reasons for wanting to study in and your expectations of the benefits you will receive.  In particular, describe the way in which the course work will fit into and enhance your degree program.

If you wish to prepare your Statement of Student Purpose using a word processor instead of typing it directly in the box below, you may do so. However, after saving your document but before copying and pasting it, you should save it again as a text file. Open the text file in a text editor, such as Notepad, then copy your statement and paste it below.
 

1. I am currently registered as a full-time, degree-seeking student at UW-Platteville. (If you check here, then
    skip the remaining questions and simply fill in the bottom of this form.)

2. I am not currently registered at UW-Platteville.  (Go on to 3 or 4).

3. I am not planning nor is a parent planning to apply for any form of financial aid (e.g., Pell Grant, Supplemental
    Education Opportunity Grant (SEOG), state grant, Perkins Loan, subsidized or unsubsidized Stafford Loan, 
    PLUS Loan, or special scholarships).  (If you check here, then skip the remaining questions and simply fill in
    the bottom of this form.)

College currently attending:

(if not currently enrolled, state "None")

Note to Students Who Have an Undergraduate Degree:
Students who have already received an undergraduate degree are not eligible for any financial aid.

Special Note to Summer Program Applicants:
If you are not currently enrolled at UW-Platteville, you cannot receive financial aid from UW-Platteville for a summer program, though you may be able to receive financial aid from your home campus via a Consortium Agreement.

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