Study Abroad

Appendix 1: Personal Information

Please enable JavaScript in your browser to complete this form.

- Step 1 of 3

Round River Program Location *

Term *

Year *

Name *

First

Last

Preferred Pronouns

Date of Birth *

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone *

Cell Phone *

School *

Major *

Save and Resume Later

authorize this Conservation

Emergency Contact 1

I understand that Round River reserves the right to notify my emergency contact of any health or behavioral concerns, policy violations, changes in my flight itinerary or other information deemed appropriate by program instructors or Round River administrative staff.

I authorize this individual to also discuss financial information (tuition, billing, etc.) with Round River Conservation Studies. *

Person to be notified in an emergency *

Relationship *

Phone *

Email *

Emergency Contact 2

I authorize this individual to also discuss financial information (tuition, billing, etc.) with Round River Conservation Studies. *

Person to be notified in an emergency *

Relationship *

Phone *

Email *

Emergency Contact 3

I authorize this individual to also discuss financial information (tuition, billing, etc.) with Round River Conservation Studies. *

Person to be notified in an emergency *

Relationship *

Phone *

Email *

Save and Resume Later

Additional Questions

If you have any dietary restrictions (e.g., allergies, gluten intolerance, religious dietary restrictions) please describe them in detail here. *

What can you eat and what can you not eat? How severe are your reactions? Is cross-contamination an issue? This information is important for our in-country staff to be able to accommodate your needs.

Please take this space to elaborate on any mental health concerns you might have (e.g., anxiety, history of depression). *

What is your plan for keeping yourself safe and happy during your program? Please note any medications you are taking and let us know if there is anything Round River instructors or staff can do to make sure you have a great semester.

If you are currently seeing a mental health specialist(s), please provide a note indicating that they do not have reservations about your participation in this program.

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

This can be uploaded here or via the secure Dropbox link that will be provided in your Program Paperwork email.

Will you require academic accommodations during your program with Round River? *

Please provide information about your personalized academic accommodations at your current institution.

If applicable, provide documentation from your institution.

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

This can be uploaded here or via the secure Dropbox link that will be provided in your Program Paperwork email.

Have you ever faced disciplinary action for academic or behavioral misconduct at any higher education institution? *

Please provide details *

What is your T-shirt size?

Save and Resume Later

Your form entry has been saved and a unique link has been created which you can access to resume this form.

Enter your email address to receive the link via email. Alternatively, you can copy and save the link below.

Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

Copy Link

Email *