Preliminary Application Form

Baker University

January 2-January 25, 2003

Interterm Program in Spain

Study in Seville

Cost: $1,575.00

Preliminary application form--Due Wednesday, September 11, 2002

Return form to:

Dr. Sandra Schumm

P.O. Box 65

Baldwin City, KS 66006

Name ___________________________________ Email ____________________________

SS# ___________________________ Age _________ GPA _________________________

Current address ______________________________________________________________

City/state/zip ________________________________________________________________

Parent or guardian ____________________________________________________________

Permanent address ___________________________________________________________

City/state/zip ________________________________________________________________

Current telephone ______________________ Permanent telephone _____________________

References from two professors __________________________________________________

Spanish classes completed ______________________________________________________

School/college where currently enrolled ____________________________________________

Health problems _____________________________________________________________ (Participants should expect to do a lot of walking on this trip. Most European facilities do not meet ADA standards.)