Albany State University - Office of International Education

Study Abroad Application Form

Fees and Passport
* To issue Acceptance Letter, a $200 Application/Deposit Fee is required for all ASU Programs. Do you agree to these terms?

Format: YYYY-MM-DD

* Do you have a passport?

Specify Passport Booklet Number

Name

Prefix

* First Name

Middle Name

* Last Name

Suffix

Your name as it appears on your passport.

Format: YYYY-MM-DD

Format: YYYY-MM-DD

Student Information
* Student Name:

Prefix

First Name

Middle Name

Last Name

Suffix

Format: YYYY-MM-DD

Specify Gender Details

Student Contact Information

Enter Email Address

Confirm Email Address

Enter Email Address

Confirm Email Address

Phone Number:

* Enter Primary Phone Number

Enter Alternate Phone Number

Local Address
* Location Address:

Street Address

Campus Location (Building and office or room number)

City

State / Province / Region

ZIP / Postal Code

Country

Permanent Address
* Location Address:

Street Address

Campus Location (Building and office or room number)

City

State / Province / Region

ZIP / Postal Code

Country

Academic Information
Academic Advisor Information
* Advisor's Name:

Prefix

First Name

Last Name

Suffix

Phone Number

Enter Email Address

Confirm Email Address

* Were you referred by any ASU Study Abroad Alumni?

First and Last Name

Maximum 3000 characters | 3000 Character(s) Remaining

Physician Information
* Physician's Name:

Prefix

First Name

Last Name

Suffix

Phone Number

Medical History

Maximum 3000 characters | 3000 Character(s) Remaining

Maximum 3000 characters | 3000 Character(s) Remaining

Maximum 3000 characters | 3000 Character(s) Remaining

Maximum 3000 characters | 3000 Character(s) Remaining

* Do you have additional medical insurance?
Additional Medical Insurance Contact Information
Emergency Contact Information