Monmouth College
Application to Study Off-Campus

A printer friendly version of this application is available here. Requires Adobe Acrobat Reader installed on your computer. To obtain this software, please click here. 

Name of Off-Campus Program:___________________________________________________

Semester Preference for Off-Campus Study:________________________________________

Applicant's Personal & Academic Information:
_____________________________________________________________________________
Name                                                                           
_____________________________________________________________________________
Home E-Mail Address                                                                                      Social Security Number
____________________________ ___________________________
College E-Mail Address                                         Major Field
___________________________  ____________________________
Campus Mailing Address                                      Expected Year of Graduation 
(___)________ (____)_________   Cumulative GPA on a 4.0 scale:__________
Day Telephone   Evening Telephone

__________________________ ___________________________
Name of Parents or Guardians                         Person(s) 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)

_____________________________________________________________________________

Letters of Reference: Click here for recommendation form (if needed).
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 college selection committee and to the program committee. By your signature you also agree to participate in this off-campus program if you are approved by Monmouth College and accepted by the program.)
Academic Advisor:_____________________________  Date:___________________
(Your signature affirms that this program is consonant with the applicant's academic program.)
Departmental Chair:_________________________________ Date:______________________
(Your signature affirms that this program fits with the applicant's major.)
Program Advisor:_______________________________ Date:___________________
(Your signature affirms that the applicant has been in contact with you about this application and the program.)
Financial Aid Officer:____________________________ Date:___________________
(Your signature indicates that the applicant has been in contact with you about financial aid for off-campus study.)
Business Officer:____________________________ Date:___________________
(Your signature indicates that the applicant has been in contact with you about fees and payments for off-campus study.)

NOTE: This application form must be accompanied by a completed application for the program to which you are applying. If no essay is required for the program application, please submit a 600-word statement explaining why you are applying for this program and how the program fits in your academic plan at Monmouth College. Applicants to AUP and to other programs which do not not include an "Agreement and Release" form must also complete this form (click here for copy).