CCIS - Student Inquiry Form

Please note: Students from outside the U.S. may not be eligible to participate in CCIS programs. Please contact the U.S. sponsoring institution listed on each program page to determine eligibility. If you are interested in studying in the U.S. please contact the United States Information Agency website: http://exchanges.state.gov/education/educationusa/

Thank you!

FIRST NAME: *
LAST NAME: *
E-MAIL ADDRESS: *
(Please confirm e-mail address) *
STREET ADDRESS: *
CITY: *
STATE: *
ZIP: *
PHONE:
COUNTRY: *
PROGRAM OF INTEREST: *
(only first choice is required)		  1st Choice
 2nd Choice
 3rd Choice
SCHOOL CURRENTLY ATTENDING:
STATE OF SCHOOL CURRENTLY ATTENDING: *
THIS SCHOOL IS A: *
ACADEMIC STATUS:
YOUR MAJOR:
WHAT LANGUAGES DO YOU KNOW?
WHEN WOULD YOU LIKE TO STUDY ABROAD?  1st Choice
 2nd Choice
 3rd Choice
COMMENTS/MESSAGE


* = REQUIRED FIELD