Communication and Culture in Italy Graduate Student Application Form
Personal Information
Name______
Last First M.I.
Student ID Number (P)______Gender: ______F ______M
Email: ______Telephone: ______
How did you hear about the Communication and Culture course? ______
Academic Information
University (if not BGSU) ______Graduate program ______
Cumulative GPA ______
Areas of specialization ______
Anticipated Graduation Date ______
Do you currently receive financial aid? If so, please state what kind (i.e., grants, scholarships, loans).
______
International, Language and Other Relevant Experience
Languages, and level of proficiency: ______
Other study abroad or relevant experience: ______
______
Emergency Contact Information
Name(s)______
Relationship______
Address______
Telephone (cell/day) ______Telephone (eve) ______
Email: ______Telephone (office) ______
(If you have additional emergency contacts, please include an additional sheet)
Health and Additional Information
Please list any allergies or other health details or other information that will be important for the program director should be aware of______
______
______
Go onto Page Two to Complete the Statement of Intent
After writing the statement of intent, please return this completed form to:
Dr. Laura Lengel, Associate Professor Phone: 419-372-7653
School of Communication Studies Fax: 419-372-0202
Bowling Green State University Email:
Bowling Green, OH 43403
Communication and Culture in Italy Graduate Student Statement of Intent
Please legibly write or type a brief essay stating why you want to participate in the Communication and Culture in Italy course and how you believe the experience will enhance both your academic and personal growth.
Part of the graduate student requirement for the course is that you will facilitate a class meeting while in Florence. Please include a discussion about what topic(s) you would like to cover and any other details about how you will make this a successful learning experience for the class (Attach separate sheets if necessary).
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Signature of Applicant Printed Name Date
and the School of Communication Studies