COVER SHEET
A complete application must be submitted in order to be considered for this program.
Checklist for Applicants
1. Applicant Information
• Passport copy
(if available at time of application)
2. Academic Information
• Transcript (Unofficial transcript accepted. Exceptions made for non-traditional students.)
3. Reference Information
• Two recommendation letters (The link to the recommendation form can be emailed directly to your
reference and returned in the methods noted below.)
4. Housing Preferences
5. Cancellation/Refund Policy
6. Essay
ICISP Sponsored Billing Agreement
(For non-District 502 students applying to Costa Rica only.)
Application Process:
Step 1 Submit completed application.
Step 2 Field Studies/Study Abroad will contact you to confirm the receipt of your
completed application.
Step 3 Program directors will contact you to schedule an interview. Acceptance into the
program is at the discretion of the program directors.
Application deadline is Feb. 15 or until all spots are filled. Late applications accepted,
space permitting.
Submit your completed application via email to benassi@cod.edu or mail to:
COD Field Studies/Study Abroad
425 Fawell Blvd., BIC 3509
Glen Ellyn, IL 60137-6599
(630) 942-2356
Application for Admission
College of DuPage Summer Study Abroad
STUAB-15-20020(10/15)
Field Studies/Study Abroad
(630) 942-2356
A $500 deposit will be required upon registration.
I am interested in participating in the program to: _____________________________________________
List Country
1. APPLICANT INFORMATION
__________________________________________________________________________________________
Last name First name Middle initial
__________________________________________________________________________________________
Permanent street address City State ZIP
__________________________________________________________________________________________
Home phone Cell phone Email
__________________________________________________________________________________________
Your address while at college if different from above City State ZIP
How long will you be at your college address? Until ____/____/____ Gender: Male Female
Do you already have a passport? (If so, submit a copy with your application.) Yes No
____________________________________________________________________________________
Name, exactly as it appears on passport Passport number Passport expiration date
____________________________________________________________________________________
Date of birth Citizenship
If your passport will expire less than 6 months from the trip return date, or you do not yet own a passport, please
apply for one now as it can take several weeks to obtain one: http://travel.state.gov/passport/get/get_4855.html
2. ACADEMIC INFORMATION (Submit transcript with application.)
__________________________________________________________________________________________
Current college Address Dates of attendance
__________________________________________________________________________________________
Previous college Address Dates of attendance
__________________________________________________________________________________________
Previous college Address Dates of attendance
Current status: H.S. Graduate Freshman Sophomore Junior Senior College Graduate
Field Studies/Study Abroad
(630) 942-2356
Application for Admission
Page 1 of 4
College of DuPage Summer Study Abroad
Note: Save a copy of these documents to your
computer PRIOR to completing them to avoid
losing your information.
__________________________________________________________________________________________
Last name First name Middle initial
__________________________________________________________________________________________
Location of Study Abroad program
Current speaking ability of language I wish to study through COD this summer:
Excellent Good Fair Poor/None
How many years have you studied this language?
High School: 0 1 2 3 4 5 College: 0 1 2 3 4 5 6 7 8
semesters quarters
Have you ever been on disciplinary probation? Yes No If yes, explain:
__________________________________________________________________________________________
__________________________________________________________________________________________
3. REFERENCE INFORMATION
Please list the names and addresses of two current or previous employers/teachers who will be
submitting recommendations on your behalf. They should have known you for at least one semester and
have observed your relationship with others. One recommendation must be from a recent teacher.
1. Name: ______________________________________________________________________________
Address: ___________________________________________________________________________
Street
____________________________________________________________________________
City State ZIP
2. Name: ______________________________________________________________________________
Address: ___________________________________________________________________________
Street
____________________________________________________________________________
City State ZIP
Recommendation Forms available online:
http://www.cod.edu/academics/field/studyabroad/pdf/recommendation_form.pdf
Page 2 of 4
__________________________________________________________________________________________
Last name First name Middle initial
__________________________________________________________________________________________
Location of Study Abroad program
4. HOUSING PREFERENCES
Preferences will be considered, but cannot be guaranteed. Check any preferences that are important to you:
Roommate Living Arrangements preferences:
Smoking Non-smoking Smoking Non-smoking
Messy Neat Pet O.K. No pets
Noisy Quiet
Morning person Night person
Punctual Not punctual
Any specific dietary requirements:
__________________________________________________________________________________________
__________________________________________________________________________________________
Three adjectives that describe you best: _______________ _______________ _______________
5. Cancellation/Refund Policy
In the event that a participant wishes to withdraw from a program for which they are registered, certain
penalties may apply. Services are planned and commitments are made on behalf of all participants, in
advance of actual departure: suppliers require advanced deposits and payments, and final payments for
all services are sent to vendors months in advance of departure. These payments are non-refundable since
contractual agreements stipulate penalties to be applied to services requested but not used.
Please note that no refunds will be made for any services provided in the itinerary that you do not use.
Please understand that if you change your plans for ANY reason, your right to a refund is limited.
All cancellations and refund requests must be made in writing and sent to:
College of DuPage
Field Studies/Study Abroad, BIC 3509
425 Fawell Blvd.
Glen Ellyn, IL 60137-6599
I have read and I understand the Participant Cancellation and Refund Policy.
______________________________________________________________ __________________________________
Signature Date
Page 3 of 4
click to sign
signature
click to edit
__________________________________________________________________________________________
Last name First name Middle initial
__________________________________________________________________________________________
Location of Study Abroad program
6. ESSAY
Please submit a one-page essay in response to the following questions: How will the program relate to your personal,
academic and career goals? What cultural experiences are you looking for during your study abroad? What do you
think will be the most challenging aspect (besides learning the language) of living in another culture? How do you plan
to prepare for and get the most out of your study abroad experience? What contributions do you hope to make as
a member of the group? Do you have previous travel experience within the U.S. or abroad (briefly discuss)? Is there
anything you would like us to know (likes, dislikes, etc.)?
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