Study Abroad Questionnaire * denotes required information
*First Name:
*Last Name:
*Date of Birth:
*Address 1:
Address 2:
*City:
*State/Province:
*ZIP/Postal Code:
*Phone Number:
*E-mail Address:
*Re-enter Email Address:
*UIU Program Select your current UIU program Fayette Campus - Residential University Independent Study Online UIU Center - Alexandria UIU Center - Ankeny UIU Center - Blackhawk UIU Center - Cedar Rapids UIU Center - Des Moines UIU Center - Elkhorn UIU Center - Fort Leavenworth UIU Center - Fort Polk UIU Center - Fort Riley UIU Center - Madison UIU Center - Milwaukee UIU Center - Prairie du Chien UIU Center - Rockford UIU Center - Waterloo UIU Center - Wausau
*Major:
2nd Major/Minor:
*Year: Freshman Sophomore Junior Senior
*Academic Advisor's Name:
*Preferred Country:
*Do You Have A Passport: Yes No
*Please write a brief paragraph on why you want to study abroad:
