Program Details
Program Location
Other Location
Program Time
Student Details
Full Legal Name
Gender
Date of Birth
Address
Phone
Email
Country of Citizenship
Passport Number (if you don’t have one yet, apply ASAP)
Passport Expiration Date
Student Academics
MSOE Major
Current Completed Credits
Anticipated Graduation Date
Are you in good academic standing with MSOE? (2.0 and above)
Faculty advisor's Name
Are you fully vaccinated for COVID-19?
Have you previously traveled abroad?
If yes, note locations and purposes
Why do you want to participate in this program?
Contacts
Name of Emergency Contact
Phone Number of Emergency Contact
Relationship to Emergency Contact