Nontraditional Part-Time Student Study Abroad Scholarship

Please enter all information completely and legibly by typing or print in ink.

Name: Mr./Ms. ______(Last) (first) (middle initial)

PeopleSoft ID: ______

Current Address: ______

Valid until: _____ - _____ - ______

Permanent Address: ______

Telephone:______Pitt Email: ______

Cell or work phone: ______Other Email: ______

Current Major in Department: ______

Cumulative QPA: ______QPA in Major: ______

Study Abroad Program or independent study you are applying for: ______

______

Name and Sponsoring Institution of your Study Abroad Program: ______

______

Location of Study Abroad Program: ______(city) (country)

Please Detail the approximate costs of your program:

Program tuition: $______Room: $______Airfare: $______

Academic status while studying abroad: sophomore ____ junior ____ senior ____

Number of credits completed by November 1, 2007: ______

Expected graduation date: ______

Have you ever studied abroad? ______If “Yes”, when, where, for how long and for what reason? ______

______

1 Name: ______PeopleSoft ID: ______

I will be available to attend the annual Excellence in CGS Reception on Friday, April 18, 2008.

Yes ______No ______

I will work with the CGS Student Government to fulfill my obligation to speak about my study abroad experience at either a CGSSG Meet-n-Greet or a CGS Alumni/Student Networking Social, during the Fall semester 2008.

Yes ______No ______

______(Signature of Applicant)

______(Applicant Name – Printed)

______(Date)

Nontraditional Part-Time Student Study Abroad Scholarship

CGSSG Study-Abroad Scholarship 3959 Fifth Avenue, 627 William Pitt Union Pittsburgh, PA 15260

You may also drop off your applications at 824 WPU from 9:00 a.m.-5:00 p.m., T-W-Th.

Applications must be received by 5:00 p.m., January 25th, 2008.