FGCU FLSA 2023 Study Abroad Application for Comparative Healthcare Systems in Europe

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Please complete the application form below for the faculty led study abroad program to Germany- Munich; Switzerland- Interlaken and Geneva; France- Paris. The FGCU faculty leader is Dr. Lesley A Clack. Please email Carey Fells, cfells@fgcu.edu with any questions regarding the application process.

First Name *

Last Name *

Your Name Exactly As It Appears On Passport (or Official Govt Issued I.D., including all middle names) *

FGCU UIN # *

FGCU Eagle Email Address (all official communications will be via FGCU email) *

Date of Birth *

YYYY

Primary Phone (xxx-xxx-xxxx) *

What is your major? *

Which category best describes you? *

Asian

American Indian

Black or African American

Hispanic or Latino

Middle Eastern / North African

White

Other

prefer not to answer this question

What is your intended graduation term? (term/year)

Are you currently an FGCU Honors College student? *

Yes

Do you have a passport? *

Yes

I am in the process of applying or renewing my passport

If not a US passport, what country issued your passport?

Emergency Contact: name *

Emergency Contact: phone number *

Please explain specifically why you are interested in this program and how it fits with your education, career, or personal goals.

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