STUDY ABROAD PROGRAM APPLICATION
EAST CENTRAL UNIVERSITY
Age
Term
GPAECU ID Number
Gender:
Passport NumberCountry of Citizenship
Country of BirthCity/State of BirthDate of Birth
Classification (ex. Junior)
Relationship
Address
City Zip Code
Email Address
EMERGENCY CONTACT INFORMATION:
Address
City
Zip Code
Last Name First Name Initial Name called
Email Address
CURRENT ADDRESS:
Male
Year
Academic Advisor
Signature
Date
Current Info Valid until
Major Minor
Course Prefix & Number
Country of Study
Female
Name
Form may be mailed to Dr. Mara Sukholutskaya, East Central University, PMB W-7, 1100 East 14th St.. Ada, OK 74820
State
Fee: $60
Short Term
State
Home Phone # Cell Phone #
Home Phone # Cell Phone #
Fee: $120
Sem. Long
Print Form
click to sign
signature
click to edit
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