Study Abroad: Guatemala Application | CSUDH CEIE

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College of Extended and International Education ► Study Abroad ► Application

Part A: Personal Data
Name:	_{(Last Name, First Name, Middle Initial)}
Cell Phone:
Current Address:	(Street, City/Province, State, Zip)
CSUDH (or other campus) E-mail:
Personal E-mail:
CSUDH (or other campus) ID No:
Major:
CSUDH (or other campus) GPA:
Check class standing that applies to you: Freshman Sophomore Junior Senior Graduate Student
Part B: Language Assesment
Please provide us with an honest assessment of your Spanish conversational ability (not reading or writing) Excellent (fluent, can carry on a conversation on most any topic with relative ease) Good (can speak fairly well most topics, as needed; grammar is not perfect) Fair (can make yourself understood most of the time with a little practice) Poor (can carry out a basic conversation on basic topics, e.g., food, bathroom) Incipient (though you may have had only one class of Spanish, and you may have trouble with many topics of conversation, you can at least speak basic greetings, have some basic vocabulary and can use the present tense). None of the above, you do not know any Spanish at all, except greetings, (buenos días, adios, etc.)
Part C: Certifications
I certify I will abide by all of the rules, policies, codes of conduct, and regulations of the CSU Dominguez Hills and of Study Abroad in particular. I certify I am in good academic and judicial standing. I understand if I fail to meet and maintain the requirements for participation in the Study Abroad program, I will be ineligible to participate and any advance payments made by me will not be refunded. I certify that I understand that withholding information requested or giving false information will make me ineligible for admissions to the program or dismissal from the program, without refund of any costs or fees paid. I have read Part C and agree to the terms outlined by California State University, Dominguez Hills
Part D: Disciplinary Verification Form
I authorize to release details of my disciplinary record(s) to the CSUDH Study Abroad Office. By signing this form I certify that I understand and authorize the release and sharing of my confidential records with the CSUDH. If there is the possibility of a change in my current status, I must discuss my case with my Dean of Student or Designee, otherwise, I may no longer qualify for a study abroad enrollment, and I may not be eligible for a refund. I have read Part D and agree to the terms outlined by California State University, Dominguez Hills
Part E: Deposit: ($250 non-refundable deposit due within 10 days of acceptance)
I, , accept that a $250 deposit is due within 10 days after acceptance. Failure to do so may make me inelligible for certain scholarships or may result in a withdrawal from the program.