PART I: Personal Information (Print or type all entries)
 

Name (First, Middle, Last)

__________________________________________________________________

 

Date of Birth

______________________________

Present Class

__________________________

 

Major subject, if applicable

____________________

Advisor

_____________________________

 

Your full campus address  P.O. Box	________________________________________________________________
City, State, Zip	________________________________________________________________

 

Your e-mail address

______________________________________________________________________

 

Address of parent or Guardian  Street and No.	______________________________________________________________
City, State, Zip	______________________________________________________________
Telephone	______________________________________________________________

If emergency address would be different, please indicate.

PART II: References

Please ask three (3) persons to submit references for you. These persons should include your faculty advisor and two other faculty/staff members. Please list the names and positions of the three.
 

Name		Position
___________________________________		___________________________________________
___________________________________		___________________________________________
___________________________________		___________________________________________

 
Part III

What travel, study, employment or living experience have you had overseas? Where? Explain circumstances. (Use back of sheet if needed.)
  PART IV

List college courses taken in history and in English literature and any others that may be applicable, including those in which you plan to enroll.
  PART V

State briefly your reason(s) for wanting to study in this program.
  PART VI

During the Program, the student must attend ALL of the lectures unless she or he has received advanced permission from the American Director to be absent. She or he must attend, participate in, and fulfill all obligations in every tutorial session.

The tutors will assess the tutorial work and submit to the American Director a grade and an evaluative discussion of the student’s work. While evaluation of the course work will rely heavily on the tutor’s evaluation, the American Director’s assessment of the lecture attendance and academic pursuit by the student will enter into the final grade.

I agree to accept the supervision and authority of the American Director of the Virginia Program at Oxford. Throughout my association with the Program, I agree to comply with the regulations covering the Program and to conduct myself responsibly. Also, I affirm that the information I have presented in this application is accurate.
 

________________________		___________________________________________
Date		Signature

 

Are you asking for financial aid? _____________

If so, how much? _______________