Study Abroad Application

 

 

Fees and Passport

 
 
 
 
 
 

 

Student Information

 
 
 
 
 
 

Ex. 900xxxxxx

 
 
 

(Race)

 
 

 

Student Contact Information

 
 
 
 
 
 
 

 

Local Address

 
 
 

(Building and office or room number)

 
 
 
 
 

 

Permanent Address

 
 

(or Campus Location, including Building and office or room number)

 
 
 
 
 

 

Academic Information

 
 

#.##

 
 
 

 

Academic Advisor Information

 
 
 
 
 
 
 
 
 

Maximum 3000 characters

 
 

 

Physician Information

 
 
 
 
 
 

 

Medical History

 

(this information is confidential, but essentials in case of an emergency)

 
 

(this information is confidential, but essentials in case of an emergency)

 
 

(this information is confidential, but essentials in case of an emergency)

 
 

(this information is confidential, but essentials in case of an emergency)

 
 

(this information is confidential, but essentials in case of an emergency)

 
 

(Please include FOOD and MEDICAL allergies)

 
 
 

 

Emergency Contact Information

 
 
 
 

 

Personal Identifiable Information (PII) Notice:

All personal data and special categories of sensitive personal data collected or processed by Albany State University (ASU) must comply with the ASU Cybersecurity Program Plan, as authorized by the Board of Regents Policy Manual Section 10.4 Cybersecurity:




https://www.usg.edu/policies




Anyone suspecting his or her sensitive personal data has been exposed to unauthorized access, report your suspicion to:




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