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Prague, Czech Republic: City of 100 Spires

Summer Sessions, 2012 Application

Prague, Czech Republic: City of 100 Spires

Description: Students participate in a month-long immersion in art history, political ideology, philosophy and travel throughout many historical areas of the city and country.

Session I: May 31–June 28
Session II: July 2–August 2, 2012

Questions about applying?
Susan Mills, Program Director
mills@gatewaycc.edu
Ph: (602) 286-8487

Required fields are marked with an asterisk.


Personal Information
Name (as it appears on your passport) *

First (Middle) Last		 Mailing Address *
 
Home phone *

Format as 602-123-4567 		City *
Mobile phone
 
Format as 602-123-4567 		State/Zip *
E-mail address *
Student ID Number 

If already enrolled at a Maricopa Community College
Date of Birth *
 
Format as m/d/yy		 Sex *
Passport Number

Leave blank if you do not have a passport 		Passport Date of Issue
 
Format as m/d/yy

How did you hear about the Prague program?
 

Specify Two Emergency Contacts
Contact #1 Contact #2
Name *
 

Relation *
Home phone *
 
Format as 602-123-4567

Work phone

Format as 602-123-4567

Address *
 

City *
 

State/Zip *
  		Name *
 

Relation *
Home phone *
 
Format as 602-123-4567

Work phone

Format as 602-123-4567

Address *
 

City *
 

State/Zip *
 

Summer Session I: May 31–June 28

Each course = 3 credit hours

Summer Session II: July 2–August 2

Each course = 3 credit hours

Academic Information I am currently enrolled at:






Other college(s) in which you are enrolled


Are you participating in this program pursuant to a degree? * If you answered "Yes" please provide details about your degree:
Major field
Minor field
Current GPA
 

How will you be taking this course?
Please list any other Study Abroad programs in which you have participated


Optional Information Ethnicity
 

Final Acknowledgements Which on-campus information session will you attend? *  
Check off all of the statements below with which you agree:




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