Study Abroad: Guatemala Application

College of Extended and International Education ► Study Abroad ► Application

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Part A: Personal Data

(Last Name, First Name, Middle Initial)

(Street, City/Province, State, Zip)

Check class standing that applies to you:

Part B: Language Assesment

Please provide us with an honest assessment of your Spanish conversational ability (not reading or writing)

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)
, 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.