1/6 Student Profile

College of Business and Economic Development Study Abroad/Away Student Profile

Personal Contact Information

Please provide your personal contact information in the spaces provided.

First Name*

Last Name*

Middle Name

Preferred Name*

USM Email*

Birth Month (Ex: August)*

Birth Year (Ex: 2001)*

Gender*

Campus*

Hattiesburg Gulfpark Online

Classification as of the departure date*

Sophomore Junior Senior Graduate Student

Major within the College of Business and Economic Development:*

Major within the College of Business and Economic Development: *

Permanent Address*

(Street, City, State, Zipcode/Postal Code/Country)

School Address*

(Street, City, State, Zipcode/Postal Code/Country)

Phone Number*

Phone Number While in Program*

Which study abroad/away program are you applying for?*

Study Away (Hawaii)

Emergency Contact Information

Please list below a minimum of two emergency contacts (usually a parent or guardian). This contact information will be provided to your on-site program director/instructor and the persons listed will be contacted in case of an emergency during your program. By listing the persons below and acknowledging your consent, you are authorizing program staff to contact and provide information including educational and financial records, contact information while overseas, information regarding your health and well-being, and any incidents on-site that may result in disciplinary action. If you have any questions or would like to limit information that can be provided to your emergency contacts, please reach out to your study abroad/away coordinator (instructor).

Emergency Contact 1: Name (First and Last)*

Emergency Contact 1: Relationship*

Emergency Contact 1: Phone Number*

Emergency Contact 1: Address*

Street Number, Street Name, City, State, Zipcode, Country

Emergency Contact 2: Name (First and Last)*

Emergency Contact 2: Relationship*

Emergency Contact 2: Phone Number*

Emergency Contact 2: Address*

Street Number, Street Name, City, State, Zipcode, Country

Academic Profile

Please answer the questions in the spaces provided below. This information will be used to determine your eligibility to participate in a study abroad/away program, and will be considered in determining eligibility for scholarships.

What is your USM ID Number? (Do not include the W)*

Major*

Major 2 (if Double Major)

Minor

Minor 2 (If Double Minor)

Classification*

Freshman Sophomore Junior Senior Graduate Student

College of Enrollment*

College of Arts and Sciences College of Business and Economic Development College of Education and Human Sciences College of Nursing and Health Professions

Current Number of Credit Hours Completed*

You can find this information in the "Academics" tab in SOAR

Academic Advisor's Name (First and Last) *

Cumulative GPA*

Cumulative GPA in Major*

Transfer GPA (If you are not a transfer student enter "Non-Transfer")*

Ethnicity

I intend to apply for financial aid.

Yes No

Financial aid includes, but is not limited to loans, grants, and/or scholarships.

Have you filed for FAFSA?*

Yes No

Are you an Honor's College Student?*

Yes No

Are you a Lucky Day Scholar?*

Yes No

Are you a College of Business and Economic Development Eagles Scholar?*

Yes No

Are you a first-generation college student?*

A first-generation college student is someone who is the first in their family to go to college.

Other Questions

Please answer the questions in the space provided.

How did you hear about this program?*