Last Name:    First:    Middle: 

SS#:     Passport #:    Student ID #:

Date of Birth:                Male         Female

Current Mailing Address:               Phone: 

 City:                            Email: 

State:     What State do you claim for residence purposes?: 

  Zip:      How long have you resided in that State?:  Years:   Months:

 Ethnic Group:  Black/Non-Hispanic                             White/Non-Hispanic              Hispanic

                        American Indian/Alaskan American        Alaskan/Pacific Islander         Race Unknown

In case of emergency, notify:     Relationship: 

Address:              Phone: 

College or University Currently enrolled at

Major:          Total Hours Completed: 

Have you requested transcripts be sent to MSU?            Yes           No

• Undergraduate non Midwestern State University Students should have their university's registrar office send official transcripts to : Dr. Larry Williams, Director, International Education, Midwestern State University, 3410 Taft Blvd. Wichita Falls, TX  76308-2099.

• Graduate Students applications are required to submit only the official transcript bearing proof of an undergraduate Degree.

How did you hear of MSU British Studies Programs/London: -Please Select- Internet Our Catalog/Brochure Electronic Mail Mail My School A Recommendation A Representative Other

  Undergraduate   Graduate   Expected Date of Graduation: Month   Year

Course and Course # you wish to take: 

            Alternate Course and Course#: 

Check the following categories that apply to you.

Name: 

Please make  $250 deposit payable to:

MSU British Studies/London 

Return the completed application form with $250 deposit to:
UHV, Study Abroad 
University West 108
3007 N. Ben Wilson
Victoria, TX 77901
 

v     Note: Deposits are not refundable unless you are refused acceptance in the Program or your course is cancelled.

v     Qualified Applicants are accepted on a first come, first serve basis.

I hereby affirm that to the best of my knowledge all information furnished on this form is complete and accurate. I understand that withholding information requested and/or giving false information may make me ineligible for admission and enrollment. I agree that a record of my academic performance may be furnished by all institutions of higher learning that I have attended. I am eligible to return to the last college that I attended.

v       I also give permission for Midwestern State University to release an official copy of my MSU British Studies/London

  Credit to my host institution          ___________________________________________
                                                                                             Applicant's Signature

v     The Director of British Studies/London has the right to terminate any student’s participation should the student be deemed a danger or a threat to the integrity of the program. I understand the director may refer my application to the MSU Counseling Center or university officials in Student Affairs before I am accepted to this program.

Date:___________________    Applicant's Signature_____________________________________

Checks should be made out to MSU British Studies/London, and For Deposit only written on the back. Applications may be FAXED to (940)397- 4840 if accompanied by VISA or MASTERCARD information.

Method of Payment:   Check       Money Order       VISA       MASTERCARD

If paying by VISA or MASTERCARD Acct. #_______________________  Exp. Date__________

Card Holder's Name as written on card_

Card Holder's Signature__________________________________________________