Study Abroad Application

Fees and Passport

Fees and Passport

Upon acceptance, an application/deposit fee is required for all ASU programs. Do you agree to the terms?

Yes

No

Program Location

Program Subject or Discipline

Program Start Date

Do you have a passport?

Yes

No

Student Information

Student Information

Prefix

First Name

Middle Name/Initial

Last Name

Suffix

RAM ID:

Ex. 900xxxxxx

Date of Birth

Gender

Ethnicity

(Race)

Shirt Size

Student Contact Information

Student Contact Information

University Email

Confirm Email Address

Alternate Email

Confirm Alternate Email

Primary Phone Number

Alternate Phone Number

Local Address

Local Address

Street Address

Do you live on campus?

Campus Location

(Building and office or room number)

City

State / Province / Region

ZIP / Postal Code

Country

Permanent Address

Permanent Address

Street Address Line 1

Street Address Line 2

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

City

State / Province / Region

ZIP / Postal Code

Country

Academic Information

Academic Information

GPA

#.##

Minor

Major

Academic Advisor Information

Academic Advisor Information

Prefix

First Name

Last Name

Suffix

Advisor's Phone Number

Advisor's Email

Confirm Advisor's Email

Were you referred by any ASU Study Abroad Alumni?

Yes

No

Semester and Course Selection

Maximum 3000 characters

Physician Information

Physician Information

Prefix

First Name

Last Name

Suffix

Physician's Phone Number

Medical History

Medical History

Recent or Current Disabilities (mental or physical) and Specials Needs

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

Recent or Current Mobility Challenges

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

Recent or Current Medical Conditions/Allergies to Medications

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

Recent or Current Psychological Care or Treatment

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

Current Medications taken on a regular basis

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

Allergies

(Please include FOOD and MEDICAL allergies)

Do you have additional medical insurance?

Yes

No

Emergency Contact Information

Emergency Contact Information

First & Last Name

Relationship

Phone Number

Personal Identifiable Information (PII) Notice:

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:

LegalAffairs@asurams.edu

Otherwise, questions concerning GDPR can be forwarded to LegalAffairs@asurams.edu. Typing your name in the box below and submission of this application provides consent to and acknowledgment of the ASU Data Security and Privacy Policy.

Please check the box below to indicate that you have read and understood the PII policy above.

Personal Identifiable Information (PII) Consent:*

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