Michigan State University s3

College of Arts and Letters MICHIGAN STATE UNIVERSITY

APPLICATION: available at www.msu.edu/~devossda/nyc; please complete this form in Microsoft Word, print it, and sign at the end before submitting it. If you must handwrite this form, please write clearly.

PART 1 BASIC AND CONTACT INFO

Name: Sex: Male Female (Last) (First)

MSU PID: Email:

Citzenship: Date of birth:

Current Address: Phone: (Street Address) (City, State, Zip)

In case of emergency, notify: Relationship to you:

Emergency contact address: Phone: (Street Address) (City, State, Zip)

Alternate emergency contact: Phone: PART 2 ACADEMIC INFO

Major: Academic advisor:

Current GPA: Expected semester of graduation:

Have you discussed your plan to participate in this program with your academic advisor? Yes No

Have you ever been disciplined for academic misconduct or misconduct in university housing? Yes No

Which classes do you intend to take as a participant in this program? (minimum is 8 credits)

AL 491: Art, Culture, and NYC (special topics, 2 credits, required for all participants) WRA 491 Special Topics: WriteNYC (3 credits) WRA 308: Invention in Writing (3 credits) AL/WRA 490: Independent Study (3 credits)

Do you plan to use Financial Aid for this program? Yes No

PART 3 REFERENCES INFO

Please provide the names and contact information for two personal references, such as professors, teachers, or former employers; do NOT list classmates or relatives.

Full Name: Email:

Address: Phone:

For how long and in what capacity do you know this individual?

Full Name: Email:

Address: Phone:

For how long and in what capacity do you know this individual?

NYC Study Away 2011 Application 2 PART 4 ESSAY

Please attach an essay of 300 words or less (approximately one double-spaced page) addressing the following question: How do you imagine that your MSU education will be enhanced by the Study Away program in New York City?

PART 5 APPLICATION FEE

Space in this program is limited. All applications must be accompanied by a $100 application fee in the form of a check or money order made out to “Michigan State University.” This fee cannot be billed to your student account. If you are not admitted to the program, the fee will be refunded. If you are admitted to the program, this $100 application fee will be applied to your program fee.

SUBMISSION APPLICATION SUBMISSION

The completed application form, essay, and application fee should be submitted as soon as possible, and no later than January 14, 2011, to:

Dr. Sarah B. Fryer, Director of Student Affairs and Advising College of Arts and Letters Michigan State University 200 Linton Hall East Lansing, MI 48824

Questions can be directed to Dr. Fryer via e-mail ([email protected]) or phone (517-355-0366).

I certify that the information provided here is correct.

Signature: ______Date:______

NYC Study Away 2011 Application 3