Berlin/Budapest/Prague 2014 Study Abroad

AN EXCITING TRAVEL EXPERIENCE THAT INVOLVES LENGTHY WALKING TOURS OF

SPECTACULAR EUROPEAN CITIES
Study abroad intended for current MDC students and alumni

PERSONAL INFORMATION
Name:
______________________________________________________________________________________
Last





First



Middle
Student ID Number:________________________________ Date of birth: ______/______/______
Current ci=zenship:___________________________________ Passport #__________________________
Gender (check one): Male_______ Female_______

Major: ________________________ Gradua=on Date:________________________

Mailing Address
______________________________________________________________________________________
Number and street




Apt. #
________________________________________________________________________________
City


State


Zip code
Cellphone number: (_____) ______________________
Personal E-mail, not mymdc.net account:_________________________________

Recommending Professor: _____________________________________________________

Payment Informa:on: NONREFUNDABLE Payment of $200.00 required to hold a place.
Check: Please make a $200.00 check payable to FT Travel Partners and aSach to form.
I, the undersigned, acknowledge that I have read the Applica=on for travel abroad and that all statements
are correct to the best of my knowledge. In addi=on, I, the applicant, authorize the release of my
transcript(s) and recommenda=ons to the academic ins=tu=ons involved in the study abroad program for
which I have applied.
I also understand that the faculty leading this program can choose to accept or deny any students
applica=on without cause.

____________________________________________________________________________________
Applicant's Signature




Date