Bergen Community College
Study Abroad Preliminary Application
Form
(Print and complete this form)
Address____________________________________________________
________________________________________________________
Phone____________________
Social Security Number: _______________________
Date of Birth: _________________
Citizenship: ___________________________
County of Residence: ____________________
Name of Person in U.S. to be notified in case of emergency:
__________________________________________________________
Phone: _____________________________
BCC
Curriculum: ___________________________
Current
GPA: __________
Number of
Credits Already Earned: _____
Number of
Credits Currently Being Taken: _____
Other
Colleges Attended: ________________________________________
Credits
Earned:____________
Country
for Study Abroad: __________________________________________
Name of
Program/College: __________________________________________
Semester: Fall
Spring Summer Year______________
Medical
Limitations: _________________________________________________
I
understand BCC will charge a $125.00 fee for each semester I study abroad.
Signature_________________________________
Date_________________
Please
attach a copy of your academic transcript of college work completed as a
required part of your application.
Bergen
Community College
400 Paramus
Road
Paramus, New
Jersey 07652