APPLICATION FOR ADMISSION FRENCH LANGUAGE AND FASHION INDUSTRY PROGRAM IN PARIS 2007

                                                                                            May 27-June 30, 2007

                                                                                COLUMBUS STATE UNIVERSITY

                                                                          Department of Languages and Literatures

Please COMPLETE clearly, and return as soon as possible to Ms. Jacqueline Konan, Department of Languages and

Literatures, Columbus State University, Columbus, Georgia 31907; or to Dr. Samia I. Spencer, 610 Little Creek Rd,

 Auburn, Alabama 36832:

Last name: ---------------------------------   First Name:  ----------------------------   Middle Name:  ---------------------------------

Student ID Number:  -------------------------------------     Date of Birth:  -------------------------------    Sex:  ----------------------

Mailing Address:  -------------------------------------------------------------------------------------------------------------------------------

Permanent Address:  ---------------------------------------------------------------------------------------------------------------------------

Home Phone Number:  -----------------------------   Cell Phone:   -----------------------------    Email:  ------------------------------

Name of College where Currently Enrolled:  ------------------------------------ Current Level: FR ---  SO --- JR  ---   SR ---

Major:  ---------------------------- GPA:  --------- Number of Semester Hours of French Completed by May 2007:  ----------

Mother’s Name:  ---------------------------------------   Phone Number:  --------------------------------   Email:  ---------------------

Father’s Name:  -----------------------------------------   Phone Number:  -------------------------------   Email:  ---------------------

Passport Number:  --------------------------------- Issue Date:  ----------------------  Expiration Date:  -----------------------------

Please attach a deposit check for $ 250 (refundable until January 31, 2007) made out to Columbus State University-

Study Abroad in France, and send it with the present application to Ms. Jacqueline Konan; or to Dr. Samia I. Spencer.

You may also pay by credit card.  Card Number:  --------------------------------------------------------------------------------------

Visa:  ---------        Mastercard:  --------        Expiration Date:  -----------------------------------

Transient students:

In addition to the present Application Form and the check for $ 250, students from institutions other than Columbus

State University will need to submit the following materials:

1.    Letter of good standing from the Registrar of your home institution

2.    Immunization records (http://www.colstate.edu/pdf_forms/immunization.pdf)

3.   An additional check for $ 25, and a completed Application for Admission as a Transient Student to Columbus State

 University (http://admissions.colstate.edu/forms.htm)

4.   Study Abroad Student Information Form (to be emailed to you upon receipt of application and check)

Autorization and Waiver of Liability 

              I acknowledge that participation in a study abroad program involves some risk of injury, illness, or loss of personal

property.  I agree to release and forever discharge the institution through which I am participating, Columbus State University

 and the Board of Regents of the University System of Georgia, its members individually, and its officers, agents, and employees,

from any and all claims, demands, rights, and causes of unforeseen bodily and personal injuries, including death, damages to

property and the consequences thereof, resulting from my participation in the 2007 Summer Program French Language and Fashion

Industry in Paris, France, and related activities.

      I certify that, to the best of my knowledge, I am in good health and physically capable of undertaking an intensive program

of foreign travel; any medical or health-related problems have been explicitly described in the student information form. I further agree

 that I shall be subject to the supervision and authority of the faculty in charge and to standards of conduct stipulated by the faculty

in charge.  I further acknowledge that the supervising faculty or program director has sole authority to make decisions regarding the

continued participation of any individual in the program whose conduct may necessitate disciplinary action.  I further authorize the

supervising faculty or program director to obtain and provide medical treatment and/or services that I may require during the study

aborad program.

      I also understand that the deadline for receiving applications is February 1, 2007, or whenever the program is full; and that

applications received after that date will be subject to a late application fee of $ 250.  The first additional payment ($ 1861.50) is due

 March 1, 2007, and the second installment ($ 1861.50) is due April 2, 2007.  I will be billed separately for tuition ($ 612 for 6 hours of credit). 

 The total cost of the program is thus $ 4585.

      CSU has the right to cancel the program due to low enrollment or unforeseen developments.

      I have read and understand the admission and attendance requirements, the refund and other policies of the Columbus State

University study abroad program entitled French Language and Fashion Industry in Paris (2007), and agree to respect them. 

I understand that I am responsible for paying the program fees at the dates indicated in the program description.