The Global Honors Program at Lock Haven University
Intent to Gain an International Experience Form
This form must be submitted at least two academic weeks before the International Experience
This form should be completed by any Global Honors Program Students who have are scheduled to
complete an international experience that would fulfill their Global Honors with Distinction
requirement. In order for this experience to count towards the Global Honors Program graduation
credentials, all students must complete and submit the International Experience Completion form and
submit a minimum two (2) page reflective essay on their international experiences when within one
month of the end of the experience (for summer experiences, this must be submitted within one month
of the beginning of the following fall semester)
Name: ______________________________________________________________________________
LHU Email: ______________________________________________ LHU ID #: ______________
Current Status in Program:
Freshmen (1-2 Semesters) Sophomore (3-4 Semesters)
Junior (5-6 Semesters) Senior (7+ Semesters)
Anticipated Dates of the International Experience: ___________________________________________
Type of International Experience:
Semester-Long Study Abroad (Location): ________________________________________________
Student Teaching Placement Abroad (Location): __________________________________________
Alternative Spring Break Trip Abroad (Location): _________________________________________
LHU Seminar Abroad (Title & Professor): _______________________________________________
PASSHE Summer Honors Trip (Location): _______________________________________________
Other (Explain): ____________________________________________________________________
Global Honors Students who study abroad for a full semester have the opportunity to earn 3 Honors
Credits for their experience by writing three (3) articles for the Occasional Word, the Global Honors
Program Newsletter. If you qualify for these credits, do you plan to take advantage of this opportunity?
Yes No
By signing below, I understand that this form does not require I participate in an international
experience, and no penalties will be incurred if I do not go forward with my plans. Additionally, I
understand that completion of this form does not constitute a record of my international experience; it
simply serves as a show of intent. I understand that to obtain the Global Honors with Distinction
graduation credential, I must complete an International Experience Completion form and write a
reflective essay within one month of my return date from the international experience.
Signature: ______________________________________________ Date: ________________
