<p> Nontraditional Part-Time Student Study Abroad Scholarship</p><p>Please enter all information completely and legibly by typing or print in ink.</p><p>Name: Mr./Ms. ______(Last) (first) (middle initial) </p><p>PeopleSoft ID: ______</p><p>Current Address: ______</p><p>Valid until: _____ - _____ - ______</p><p>Permanent Address: ______</p><p>Telephone:______Pitt Email: ______</p><p>Cell or work phone: ______Other Email: ______</p><p>Current Major in Department: ______</p><p>Cumulative QPA: ______QPA in Major: ______</p><p>Study Abroad Program or independent study you are applying for: ______</p><p>______</p><p>Name and Sponsoring Institution of your Study Abroad Program: ______</p><p>______</p><p>Location of Study Abroad Program: ______(city) (country)</p><p>Please Detail the approximate costs of your program:</p><p>Program tuition: $______Room: $______Airfare: $______</p><p>Academic status while studying abroad: sophomore ____ junior ____ senior ____</p><p>Number of credits completed by November 1, 2007: ______</p><p>Expected graduation date: ______</p><p>Have you ever studied abroad? ______If “Yes”, when, where, for how long and for what reason? ______</p><p>______</p><p>______</p><p>______</p><p>1 Name: ______PeopleSoft ID: ______</p><p>I will be available to attend the annual Excellence in CGS Reception on Friday, April 18, 2008.</p><p>Yes ______No ______</p><p>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.</p><p>Yes ______No ______</p><p>______(Signature of Applicant)</p><p>______(Applicant Name – Printed)</p><p>______(Date)</p><p>Nontraditional Part-Time Student Study Abroad Scholarship</p><p>CGSSG Study-Abroad Scholarship 3959 Fifth Avenue, 627 William Pitt Union Pittsburgh, PA 15260</p><p>You may also drop off your applications at 824 WPU from 9:00 a.m.-5:00 p.m., T-W-Th. </p><p>Applications must be received by 5:00 p.m., January 25th, 2008.</p><p>2</p>