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Application For Monmouth College Exchange Program
Personal & Academic Information:
_____________________________________________________________________________
Name
Date of Birth
Sex
_____________________________________________________________________________
Home E-Mail Address
Country of Birth Social Security Number
___________________________
____________________________
College E-Mail Address
Major Field|
_________________________
______________________________
Your Address at College
Anticipated academic standing at start of program
____________________________
City
State
Zip Anticipated Year of Graduation:___________
(___)____________(____)_______ Cumulative GPA on a 4.0
scale:__________
Day Telephone
Evening Telephone
___________________________
_____________________________
Name of Parents or Guardians
Persons to be notified in case of emergency
___________________________
___________________________
Home Address
Address (if different from home address)
___________________________
___________________________
City
State Zip
City
State Zip
(___)_______ (____)__________
(____)__________________
Day Telephone Evening Telephone
Telephone (if different from home telephone)
If you will be off-campus, where can we contact you during the application process? Give an address, phone number,
and specific dates:
_____________________________________________________________________________
References:
1) Name__________________________Title and Department:___________________
2) Name__________________________ Title and Department:___________________
3.) Name__________________________Title and Department:___________________
Required Signatures:
Applicant:____________________________________________ Date:___________________
(Your signature grants Monmouth College permission to send a copy of your academic transcript to
the participating school.)
Academic Advisor:_____________________________________ Date:___________________
(Your signature affirms that this program is consonant with the applicant's academic program.)
Dean of Students:______________________________________ Date:___________________
(Your signature indicates that, to the best of your knowledge, the applicant has demonstrated the emotional stability
and maturity to participate in an off-campus program requiring adjustment to a different environment and intensive
interaction within a small group of students.)
Dean of the College:____________________________________ Date:___________________
NOTE: Applicant does not obtain this signature.
Monmouth College
Exchange
Please briefly answer the following questions on an additional sheet of paper. Be sure to
number your responses and attach the additional sheets to the application form.
Academic Background:
1. List all courses not on your transcript that you will have completed before the beginning of the
program.
2. What course work and reading have you done which would serve as
preparation for your participation in this exchange program.
3. Have you participated in an independent study program or research project? If so, please
describe the work and the end product.
4. List any scholastic honors or awards.
5. List any other extracurricular activities, positions, or awards.
Foreign Language Skills:
6. How much formal study have you had in the language spoken in the
host county? If you have no background in this language, what
language training do you plan to take before the start of the program? (Monmouth College
requires proficiency in French at the 101 level for participation in the ESGCI program.)
Other Information:
7. If you have ever traveled or lived in any other country, please describe your
experience.
8. Do you have any health problems about which we should be informed like food restrictions,
allergies, special medications, or disabilities? If yes, please describe your requirements.
Essays:
Please answer the following two essay questions on a separate sheet of paper. Essays should be
about 300 words, typed and proofread, and reflect the depth of your interest in this program.
1. Explain in some detail why you want to participate in this program, with particular reference
to academic and personal goals.
2. Discuss any particular strengths which you feel would contribute to a successful experience in
the program, (e.g., academic background, previous travel or contact with other cultures, extra
curricular activities, special interests).
In addition, please complete the
"Agreement and Release" form and distribute copies of this recommendation
form to three instructors who know you well.
This webpage was prepared by Professor
Thomas J. Sienkewicz of Monmouth College.
If you have any questions, you can contact him at toms@monm.edu.
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