Study Abroad Program in Germany

Auburn University

College of Business

Study Abroad Program in Germany

Pforzheim University of Applied Sciences

Name______

Date of Birth______Student ID No.______Male_____ Female_____

Permanent Address______Phone______

______

______

Current Address ______Phone______

______Email______

Presently enrolled at______Academic Classification______

Academic Major______Academic Minor______Degree______

Auburn University students must complete a Study Abroad/Exchange Course Approval Form and be registered for an Auburn Abroad course to receive appropriate credit. All students must have adequate health insurance coverage and complete Release from Liability forms through the Study Abroad Office.

Name of Health Insurance Company______Policy Number______

Person to notify in case of emergency:

Name______Relationship______

Phone______Address______

E-mail______

_____Check if you are requesting financial aid. (Auburn University students should contact Charles Markle in the Financial Aid Office at 844-4367.)

Program fee: $3150 per term. For Auburn University students, an Auburn Abroad fee of approximately $540 for residents and non-residents will be billed additionally to participate in the program through Auburn Abroad. Fees are subject to change.

Participants’ Signature______Date______

Parent or Guardian’s Signature______Date______

(if participant is less than 19 years of age)

Please return, by April 15 for Fall term and September 15 for Spring term, the completed application form and your non-refundable $200 deposit to:

Auburn University-College of Business

Study Abroad Program in German, Pforzheim University

Office of the Dean – Attn: Dr. Amit Mitra

Suite 516

Auburn University, AL 36849

Phone: (334) 844-4030 Balance, less deposit is due no later than July 1 for Fall term or

FAX: (334) 844-4861 December 1 for Spring term.

Make check payable to Auburn University-College of Business