University of Puerto Rico at Mayaguez Summer Program - pg电子下载 State University-pg电子下载

Education, Research, and Cultural Exchange Experience Application and Information Sheet

Education, Research, and Social Engagement: pg电子下载 State University- University of Puerto Rico at Mayaguez

July 6-19, 2025

First Name

Middle Name

Last Name

Student ID Number

Gender

Male

Female

Campus/Local Address

City/State/Zip

Phone Number

Email Address

Information Valid Until

Date of Birth

Permanent Home Address

Permanent Phone Number

Academic Major(s)

Academic Minor(s)

Cumulative GPA (Minumum 3.0 GPA)

Academic Advisor(s)

Academic References

Name

Department

Email Address

Phone Number

Campus Address

Name

Department

Email Address

Phone Number

Campus Address

Please describe any medical problems (including any allergies and required medicines) which would have an effect on your stay.

Special accommodations or needs that must be considered in placing you in an experiential learning program (please describe).

Are you attending any summer internships, study abroad programs, or student experiential learning opportunities that may pose a conflict with this travel?

Previous Travel

Have you ever studied or lived outside of the United States?

Yes

No

When and how long?

Have you ever traveled, studied or lived outside of the United States?

Yes

No

Have you studied any foreign languages?

Yes

No

If Yes, what language(s)?

Why would you like to participate in this program? (Give a brief summary.)

How did you hear about this program?

Community Involvement/Service

Please list the organizations and activities you have been involved in, along with your role (example: SMILE, Jr. MANRRS, 4-H, Pre-College program, community service).

Organizations, clubs, etc.

Community Involvement and Service

Leadership Experience, Honors or Awards

May the Center for Global Programs release your name, address or picture for publicity?

Yes

No

I certify that all statements on this form are true and accurate to the best of my knowledge. I give permission to the selection committee to verify the information provided in this application and to be published in a press release should I be awarded. Also, I will provide additional documentation if requested. I understand that if I am selected, I will be required to participate in each aspect of the program and to follow the standards set by the Experiential Learning Program.

Name

Date

In Case of Emergency

Name

Relationship

Phone Number

Address

For information about this education, research, and cultural exchange experience, contact:

Dr. Victor Njiti
(601) 877-2446 | [email protected]

Dr. Tatiana Height
(601) 877-3975 | [email protected]

Note: All applicants must submit a current official university transcript.

This program is supported in part by funds from USDA/NIFA #2024-38821-42043.