Please Indicate Semester:Fall, ______

APPLICATION FOR ADMISSION

CANISIUSCOLLEGE’S STUDY ABROAD PROGRAM
ATLANTIS SCHOLAR PROGRAM
Name: Last______First______
Student ID#______
Soc. Sec. Number______
Date of Birth ______Citizenship______
Current Mailing Address______
City______
State______Zip ______
Phone # ( )______
Permanent or Home Address ______
City______
State______Zip ______
Phone # ( )______
Cell Phone# ( ) ______
E-mail______
Person to be Notified in Case of Emergency:
Name ______
Address ______
City ______
State ______Zip______
Home Phone # ( )______
Cell Phone # ( ) ______
Business Phone # ( )______
PERSONAL INFORMATION
Have you been involved in any disciplinary situations in the past at Canisius or any other college or university? If so, please explain.
______
______
______
______
Do you have any medical, physical or psychological problems that would restrict any active participation in study or travel? If yes, please note below.
______
______
______

Please Indicate Semester:Fall, ______

Spring, ______

ACADEMIC INFORMATION

Proposed subjects of study while abroad in order of preference:
1. ______2. ______3. ______
Circle Current Status: Sophomore Junior Senior Graduate
Major Field of Study: ______Minor Field of Study: ______
Year of Graduation: ______Overall G.P.A. ______G.P.A. in Major Course ______
List any other institutions previously attended at the college level and dates of attendance:

Please provide the name and title of two faculty members who will complete an academic reference on your behalf.

Name Title

Name Title

CHECKLIST

I, the undersigned, acknowledge that I have read the CanisiusCollege Application and that all statements are correct to the best of my knowledge. In addition, I, the applicant, authorize the release of my transcript(s) and recommendations to the selection committee.

Signature ______Date ______

____ TRANSCRIPT: Youmust submit coursework from all colleges and universities that you

have attended, including Canisius. The Canisius transcript must be obtained from the Registars’s Office. Your application cannot be reviewed until transcripts are received.

____ COMPLETED DEGREE AUDIT: In order to run and print a degree audit please go to

Select Current Student option. Under On-line

Tools, select On-line registration/check your grades/view your 1098-to run GriffAudit option

-Login to Secure Area using your Griffmail username and password.

-Select Student Services option.

-Select Records option.

-Select GriffAudit (Degree Audit) option.

-Select Submit and Audit option.

The audit will allow you and the committee to determine your remaining degree requirements and your ability to take appropriate courses while studying abroad.

____ RECOMMENDATION FORMS: Completed by two faculty members.

____ DEADLINE: All applications must be submitted by March 1 to be eligible for the Fall

Semester. The deadline for the Spring Semester is October 1st.

____SUBMIT TO: ESTHER A. NORTHMAN

Director of International Student Programs

CanisiusCollege

2001 Main Street

Buffalo, NY 14208

(716) 888-2784 Fax (716) 888-3191