GEP Application Form

University of Illinois at Springfield
Study Away Programs
Application Form

1. Please check the appropriate box:

UIS student applying for a UIS program

UIS student applying for a non-UIS program

Non-UIS student applying for a UIS program

4. Are you a UIS student

Other, please specify:

If you are a student, complete questions 7 - 10 (skip if not a student)

If you are a student, complete questions 7 - 10 (skip if not a student)

11. Which program are you applying for?

A) UIS Short Program (complete questions 12 - 14)

B) UIS Exchange Programs ( complete questions 15 - 16)

C) Non-UIS Programs (complete questions 17 -19)

14. A) If you are applying for a UIS short-term study program are you intending to enroll for credit?

Emergency Contact Person Information: Complete questions 30 - 36.

Emergency Contact Person Information: Complete questions 30 - 36.

Travel Related Information

Travel Related Information

41. Do you have a valid passport?

Qualifications:

Qualifications:

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GEP Application Form

GEP Application Form

2. First Name:

3. Last Name:

5. If you checked no and you are a student, please indicate which college/university you are attending at present

6. If you are not a student, please indicate your current profession

7. UIN #(for UIS students)

8. Major

9. Year in school and/or credit hours earned by application deadline:

10. Anticipated date of graduation:

Program to which you are applying:

12. A) UIS Short Term Study Programs: Program name:

13. A) Program dates

15. B) UIS Exchange Programs: Program name:

16. B) Program dates:

17. C) Non-UIS Programs Program Name/ Sponsoring Institution

18. C) Program Dates

19. C) Provide the following information IF YOU ARE APPLYING FOR A NON UIS program: - Contact Information (Name, Address, Phone, Email) - Cost of program (in USD) - Program Prerequisites

Contact Information

20. Current Address

21. City

22. State

23. Zip code

24. Telephone:

25. E-mail

26. Permanent home address (if different)

27. City

28. State

29. Zip code

30. Full Name:

31. Address

32. City

33. State

34. Zip code

35. Telephone

36. E-mail

37. Date of Birth

38. Place of Birth

39. Citizenship

40. If not a U.S. Citizen please enter your alien registration number or your visa type (F1, J1, etc.)

42. Passport Number

43. Expiration Date

44. Health Information: Please list any disabilities (hearing, learning, orthopedic, psychological and chronic, etc.) you have. Please note that most UIS seminars require moderate walking and that some of the sites that will be visited on UIS seminars might not be completely ADA accessible.

45. List any medical conditions (allergies, etc.) you have

46. List any dietary restrictions you may have

47. List all prescription medicines you are taking

49. List the courses that you have taken that are required or relevant to your proposed program of study.

50. List any extra curricular activities, hobbies, awards, honors, and/or University recognition (we use this information for home stays for selected programs):

51. List recent work experience, internships or other relevant information (we use this information for home stays for selected programs):

53. Essay upload (maximum file size: 15MB)

Save and Finish Later

17. C) Non-UIS Programs
Program Name/ Sponsoring Institution