Apply to AYA Study Abroad

AYA Study Abroad Online Application Form

*First Name

Middle Initial

*Last Name

CURRENT ADDRESS

*Street Address

*City

*State

*Zip Code

*Home Telephone #

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Cell Phone

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*Email Address

*Name of College/University (if Senior in High School, put High School name)

State Your School is Located in

Cumulative College/University GPA

Current Year in School

PERMANENT (PARENT/GUARDIAN) ADDRESS

-If you have an Apt. or PO Box number, please be sure to include it.

*Street Address

*City

*State

*Zip Code

*DO YOU WANT MAIL SENT TO YOUR CURRENT ADDRESS OR PERMANENT ADDRESS?
 My current address My permanent address

PERSONAL INFORMATION

*Date of Birth

*Age

*Place of Birth (City, State, Country)

*Social Security #

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*Gender
 Male Female

Passport # (if available)

Expiration Date

Country of Citizenship

If you don't have a passport yet, please apply for one right away, as your passport number may be needed up to 3 months before departure for visa and enrollment purposes. Passports can take up to 6-8 weeks to process by regular service.

PARENT/GUARDIAN NAMES

*Name #1
First Name : Last Name :

Name #2
First Name : Last Name :

Name #3
First Name : Last Name :

Name #4
First Name :Last Name :

*Which parent would you want us to contact first in an emergency?

Other

*Parent/Guardian Emergency Contact #

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* I will be paying for the program using
 My own or parent's money Financial Aid issued by my college/university Financial Aid Office Personal or bank loan

Please note: program fees will be billed directly to the student, and the student is responsible for making payment arrangements.

PROGRAM INFORMATION

*The city I want to study in is:

*I want to go in:
of

How well do you speak and understand the local spoken language?
 Beginner Low Intermediate Intermediate High Intermediate Advanced

How well do you read and write the local language?

Additional Comments:

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