Hobart and William Smith Colleges

Off Campus Programs

Application
For Office Use Only
Date Recieved_________
Transcript_________
GPA_________
Essay_________
Sent To_________

 

 

 

__________________________________________ ___________________________
(Name of Program) (Academic Term Offered)

This form is to be completed by any student who intends to participate in a Hobart and William Smith Colleges off-campus program. Please note that additional forms may be required for certain programs. If you have any questions regarding the application procedure, please contact the Off-Campus Programs Office, Coxe Hall, 2nd floor (ext. 3307 or email ocp@hws.edu). Please return the completed application to the Off-Campus Programs Office.

NAME ____________________________________________ CLASS OF ___________
SOCIAL SECURITY NUMBER ______________________________
CAMPUS P.O. BOX ___________________

HOME ADDRESS
  ___________________________
LOCAL PHONE ___________________ ___________________________
HOME PHONE ___________________ ___________________________
E-MAIL ADDRESS_____________________________________________________
OTHER PROGRAM(S) YOU MAY BE INTERESTED IN ______________________________________________
OTHER OFF-CAMPUS PROGRAMS IN WHICH YOU HAVE PARTICIPATED__________________________
____________________________________________________________________________________________
ARE YOU A UNITED STATES CITIZEN? YES________ NO__________
DO YOU HAVE A PASSPORT? YES _______ Expiration Date __________ NO ________

Do you have any special needs or allergies that we should be aware of (i.e. vegetarian diet, allergies to food or medicines): _________________________________________________

PERSONAL STATEMENT - Please respond to the following questions in 3-5 pages:

  1. Describe the ways in which participation in this off-campus program will help you meet your academic goals. How the program address major and/or minor requirements?
  2. Describe qualifications you have for participation in this program, including language training, prerequisite course work, or special background.

Your personal statement will be very important when your application is reviewed. Please take the time to write carefully and thoughtfully. Attach your typed personal statement to this application.

Please list the courses you intend to elect and indicate any that will meet requirements for your major and/or minor: ____________________________________________________________________________________________

RELEASE FORM: I authorize release of my academic transcript and medical, disciplinary, and other records maintained by Hobart and William Smith Colleges to those program administrators responsible for selecting program participants and safeguarding their health and well-being.

SIGNATURE ________________________________________ DATE ____________

NAME OF ACADEMIC ADVISOR ____________________________________________

NOTE TO ADVISOR: Your signature represents your approval of this student’s participation in this program, and your assessment that participation will not compromise progress toward meeting major, minor, or graduation requirements.

SIGNATURE OF ACADEMIC ADVISOR ________________________ DATE _______

List two personal references from the faculty, administration or staff:

1) ___________________________________________ Phone _________________

2) ___________________________________________ Phone _________________

DEADLINES:

For Fall '01 and Full-Year '01-'02:
All HWS programs by October 27, 2000
All non-HWS programs by January 26, 2001

For Spring '02:
All HWS programs - Jan. 26, 2001

return all application materials to the off-campus programs office, coxe hall, 2nd floor.