A check in the amount of $200 made payable to Walsh University must be submitted to Global Learning Program, Walsh University, 2020 East Maple St., North Canton, Ohio 44685, before your application will be considered. This application deposit will be considered part of your program fee.

Global Learning Application

* = Required

Programs

Please check the program you are applying for* Rome Experience (Spr. 09) - Deadline Oct. 10, 2008 Rome 4-week Program (Sum. '09) - Deadline Feb 20 Museum Studies Prg. (Sum. '09) - Deadline Feb. 20 Kisubi, Uganda (Sum. '09) - Deadline Feb. 20 Rome Experience (Fall I '09) - Deadline Feb. 20 Rome Experience (Fall II '09) - Deadline Feb. 20 Other (please describe) Decription

Personal Data

Last Name* First Name* Middle Name Preferred Name Student ID # Male/Female Male Female Birthdate Age Citizenship I have a passport Yes No Street Address City State Zip Home Phone #* Cell Phone # Campus Phone # E-mail Address Walsh E-mail Address Alternate Mailing Address (Provide only if you wish to have mailings sent to this address after April 24, 2009). Relationship to you

Emergency Information

Name Home Phone # Work Phone # Cell Phone # Street Address City State Zip

Eligibility

I meet the standard eligibility requirements Yes No Major GPA Walsh credit hours earned to date I am currently a Freshman Sophomore Junior Senior Graduate Student Alumnus Other

Accommodations

Accommodations (Note: Single accommodations are not always available and are an additional cost.) I prefer single accomodations I have selected a roommate (provide name below) Roommate name

Transportation

Transportation (Making your own arrangements is not an option with all trips - Call 330-490-7105 for details.) I will be departing and returning with Walsh group I will make my own arrangements for transportation

Special Needs

Special needs? (Please describe)

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