Apply Now General Information Legal Name * First Name Last Name Preferred Name First Name Last Name Sex on birth certificate * Gender Identity Date of Birth * MM DD YYYY City & State of Birth * Local Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Alternate Email Phone * (###) ### #### Permanent Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Citizenship * Major * Minor GPA * University * Summer 2025 Course (Course Number & Title) * Emergency Contact Information Name * First Name Last Name Relation * Phone * (###) ### #### Cell (###) ### #### Email * Agreement & Signature I certify that all of the above information is correct, and I agree to stand by the financial, academic, and conduct policies and procedures set forth by Italy Abroad Program and partner institutions. I also certify that I am authorized to perform transactions using the card information provided and authorize a charge for the specified amount to the above specified account. I understand that Italy Abroad Program and its affiliated institutions, in arranging these programs, act only as agents. As such, neither Italy Abroad Program nor any of its employees, or persons, parties, organizations, or agencies collaborating with them, is or shall be responsible or liable for injury, loss, damage, deviation, delay, curtailment, however caused, or the consequences thereof which may occur during any travel or program. Italy Abroad Program and the sponsoring institution reserve the right to cancel or alter any program or course for any reason. IMPORTANT: It is every student’s responsibility to ensure that you've carefully reviewed each link in detail before checking the boxes below. By clicking the boxes and signing below, I certify that I understand and agree to the terms described above, as well as the liability waiver, housing contract, alcohol agreement form, cancellation policy, and student code of conduct. * I agree to the terms described above I agree to the liability waiver I agree to the housing contract I agree to the alcohol agreement form I agree to the cancellation policy I agree to the student code of conduct Student Signature * Please type your legal first name and legal last name. Today's Date * Please select today's date MM DD YYYY Thank you!
