University of Rwanda Summer Program - Alcorn State University

Study Abroad Application and Information Sheet

Tropical Agriculture, Ecology, and Environmental Sustainability Research and Education in Rwanda: Alcorn State University- University of Rwanda Summer Program

First Name

Middle Name

Last Name

Student ID Number

Gender

Male

Female

Campus/Local Address

City/State/Zip

Phone Number

Email Address

Information Valid Until

Date of Birth

Permanent Home Address

Permanent Phone Number

Academic Major(s)

Academic Minor(s)

Cumulative GPA

Academic Advisor(s)

Academic References

Name

Department

Email Address

Phone Number

Campus Address

Name

Department

Email Address

Phone Number

Campus Address

Please describe any medical problems (including any allergies and required medicines) which would have an effect on your stay abroad.

Special accommodations or needs that must be considered in placing you in a study abroad program (please describe).

Have you ever studied or lived outside of the United States?

Yes

Have you ever traveled, studied or lived outside of the United States?

Yes

Have you studied any foreign languages?

Yes

If Yes, what language(s)?

Why would you like to participate in this program? (Give a brief summary.)

How did you hear about this study abroad program?

Community Involvement/Service

Please list the organizations and activities you have been involved in, along with your role (example: SMILE, Jr. MANRRS, 4-H, Pre-College program, community service).

Organizations, clubs, etc.

Community Involvement and Service

Leadership Experience, Honors or Awards

May the Center for Global Programs release your name, address or picture for publicity?

Yes

I certify that all statements on this form are true and accurate to the best of my knowledge. I give permission to the selection committee to verify the information provided in this application and to be published in a press release should I be awarded. Also, I will provide additional documentation if requested. I understand that if I am selected, I will be required to participate in each aspect of the program, and to follow the standards set by the Study Abroad Program.

In Case of Emergency

Name

Relationship

Phone Number

Address

For information about this study abroad program, contact:

Dr. Victor Njiti (601) 877-2446 | [email protected]

Dr. Bryon Johnson (601) 877-6543 | [email protected]

Note: All applicants must submit a current official university transcript.

This program is supported in part by funds from USDA/NIFA #2015-38821-24360.

USDA United States Department of Agriculture National Institute of Food and Agriculture