Fillable Application for Summer Program (Heidelberg College)

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Application for Summer Program (Heidelberg College)

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The Application for Summer Program (Heidelberg College) form is 3 pages long and contains:

  • 3 signatures
  • 13 check-boxes
  • 46 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Heidelberg College

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1
Application for Summer Program
Program Cancellation and Changes. I understand that Heidelberg University reserves the right to cancel the program and to make changes or
alterations in the program and/or program itineraries at any time as may be required because of emergency, changed conditions, or the University’s
determination that such cancellation, changes or alterations are in the best interest of the program or its participants. I further understand that the
University is not responsible for changes or alterations to or cancellation of programs by the host institution. Heidelberg University shall have no
liability to any participants, their parents or any other third party for the cancellation of the program or any changes or alterations to the program.
Please consider my application for the: Summer of Study Application Deadlines:
Heidelberg Summer Program 20_______ March 1
General Background Information
Full Name of Applicant
(Last, First Middle)
Home Address College Address
Home Phone Cell Phone
School Email Social Security Number
Alternate Email Citizenship
Date of birth (mm/dd/yy) Please check one item below:
Gender: Male
Female
Other
1. I have/am applying for a U.S. passport.
2. I am not a US or EU citizen and will be applying for
a visa at the German embassy in
(list city)
Emergency Contact Name __________________
Address
Phone
Cell
Email
2
Academic Information
College/University
Current Standing
Freshman
Sophomore
Junior
Senior
Cumulative GPA Equivalent Letter Grade:
Major(s) Minor(s)
Highest level of College German taken (if applicable)
Other interests, hobbies, volunteer experiences
Billing Information
The summer program bill will be sent to the student’s email. If you would like someone else to receive a copy,
please indicate below.
Program Billing:
Name
Address
Phone Fax
Email
Where did you hear about the Heidelberg Summer Program?
AJY Website Study Abroad Office Advisor Professor Internet
Campus visit by AJY Program representative Other
Signature Today’s Date
click to sign
signature
click to edit
3
310 E Market Street
Tiffin OH 44883
419-448-2062
Fax: 419-448-2217
Email: ajy@heidelberg.edu
Hei
delberg Summer Program Information Waiver
Student’s Name
The Family Education Rights and Privacy Act of 1974 and its amendments guarantee students
access to their educational records. Students, however, are entitled to waive their rights of access
concerning recommendations. The following signed statement is the applicant’s wish regarding
these recommendations.
I waive my rights to inspect the I do not waive my rights to inspect the
contents of my references for the contents of my references for the
Heidelberg Summer Program Heidelberg Summer Program
signature date signature date
Please provide the name and email for your Academic/Personal Reference, which should be
completed by someone who can attest to your qualities, such as an advisor or a faculty member
(other than your German reference):
Name Email
Please provide the name and email for your German Language Reference, which should be
completed by your most recent German professor (only applicable if you have studied German):
Name Email
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Application for Summer Program (Heidelberg College)

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Completed 21 August 2020

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