Doing Business in Latin America

NICARAGUA

Doing Business in Latin America:

Challenges and Opportunities

Please email, mail or deliver the application with a copy of your passport (if available) and a deposit check for $100 made payable to: Thomas More College by November 3, 2014. Mail to: Lynnette Guzzino, Thomas More College, 333 Thomas More Pkwy., Crestview Hills, KY 41017.

Personal Contact Information

Name______

First/Middle/Last

Please print name as it appears, or will appear, on your passport.

Your airline ticket will be issued in this name and the names on these two documents MUST be identical.

Current Address______

Street/City/State/Zip Code

Permanent Address______

Street/City/State/Zip Code

Phone______Email______

(Include area code) (Please check email regularly for important program updates.)

Cell Phone______

Male / Female Age______Date of Birth______

Please notify Dept. of Business Administration (859 344-3621), if there are any changes to your personal contact information.

Emergency Contact

Name______Relationship______

Address______

Street/City/State/Zip Code

Phone______Email______

(Include area code) (Please provide email address which is checked regularly.)

Cell Phone______(Include area code)

Academic Information

Major(s) ______Minor(s)______

Degree Seeking Student: Yes / No

Freshman / Sophomore / Junior / Senior / Graduate / Other ______

Are you enrolling in a credit bearing course(s) related to this program? Yes / No

Course titles(s) and number(s) ______

Student ID #______

Accommodations

Please list your rooming preference below. NEP will attempt to accommodate all requests.)

I prefer Single accommodations (at an additional cost and if available).

I prefer double accommodations.

(I prefer to room with the following individual______)

Travel Information

Previous Experience Abroad______

______

Foreign Language Skills______

Fluency Level: Beginner / Intermediate / Expert

Special Requirements

Dietary Requirements (i.e. vegetarian, allergies, etc.) ______

______

Other______

Initial deposit of $100.00 is refundable if you withdraw before 12/31/2014. You will be given a schedule of three payments for the balance of the trip during Jan-March, 2015.

______

Signature Date