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Semester Programs: The Netherlands

Online Application (Due May 1, 2012)

Note: Use "Tab" to go from field to field. Pressing "Enter" submits the application and does NOT move from field to field.

Last name:

First name:
Middle name: Student number:
Birth date (M/D/Y): Citizenship:
   
Local/College address:
Local zip code: Local phone:
Permanent home address:
City:   State/Province:    Zip code:
Permanent home phone:
Summer address (if different from perm.):
City:   State/Province:    Zip code:
Summer phone number:
Campus email address: (required)
Other email address, if any:
Passport?*
Expiration date:
Passport no:

*If accepted to the program, you will need to apply for a passport immediately if you don't already have one.
Major Concentration:
Minor Concentration:
Anticipated class level (Spring '13):
Cumulative GPA (min 2.5):
Advisors Name:
Students participating in the Semester in The Netherlands program are required to take a 1-semester-hour Dutch language and culture course in the Interim prior to departure. (Another Interim course may be taken in addition to this course.) Exemptions will be given to students who have already taken a Dutch language course during the semester (i.e. Dutch 101). Do you plan to take any Dutch language courses prior to Interim 2010?"

ESSAY

Please write a brief essay (at least 200 words) on the reasons you are interested in this program. List previous coursework that helps prepare you for the program, and show how participation in this program would benefit you educationally and personally.

RECOMMENDATIONS
Please list the names and phone numbers for the two persons who will fill out the recommendation forms for this program. At least one reference must be a professor who has had you as a student. Recommendation forms should be completed online or printed and faxed to Off-Campus Programs at 616-526-7149.

Name of Faculty Reference
(last, first):
Phone:
Name of Second Reference
(last, first):
Phone:


OFFICIAL STATEMENT

By submitting this application, I agree that I have given two (2) recommendation forms to individuals to be completed and returned. I also acknowledge that I relinquish the right to see these recommendations unless I have informed my recommenders in writing that I wish to retain that right.

I also agree to participate fully in the academic program and excursions for the duration of this program.

I understand that any applications received after the application deadline may not be considered for the program.

APPLICATION GUIDELINES

Only complete application forms will be considered for the program. The Application and Recommendation Forms must be received by the Program Director by the application deadline.

Students with disabilities: The Off-Campus Programs Office will collaborate with the Services for Students with Disabilities Office to provide necessary accommodations of documented disabilities to the extent possible, provided that the student notify a disability coordinator of his/her need for appropriate accommodation at least three months prior to the beginning of the off-campus program. Please note, however, that accommodations available on Calvin’s campus are not always possible in an off-campus setting.

Students currently under treatment for a physical or mental condition: Any student accepted to the program who is currently being treated by a health professional will be asked to get the approval of that physician, therapist, or counselor for his/her participation in the program, since the same level of treatment is normally not possible at Calvin’s off-campus sites.

 

 

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