Full Legal Name
Date of Birth
Country of Citizenship
Passport Number (if you don’t have one yet, apply ASAP)
Passport Expiration Date
Current Completed Credits
Anticipated Graduation Date
Are you in good academic standing with MSOE? (2.0 and above)
Faculty advisor's Name
Have you previously traveled abroad?
If yes, note locations and purposes
Why do you want to participate in this program?
Name of Emergency Contact
Phone Number of Emergency Contact
Relationship to Emergency Contact