Name_____________________________Social Security Number______________________

Home Phone_______________________School Phone_______________________________

Home College or University______________________________________________________

Total Cost of Home College or University per Year____________________________________

Overseas University_______________________ Term Spring 20___Fall 20___Year 20___/___

List all forms of financial aid and the amount you received this year (including scholarships, loans, grants, and work-study).

1.

2.

3.

4.

5. Amount of family contribution per year:

Please list all forms of financial aid and the amount you expect to receive during your study abroad semester or year:

1.

2.

3.

4.

5. Estimated family contribution for study abroad:

Scholarship Information
Scholarships are awarded in the form of a credit toward the overall program fee balance. Scholarships cannot be used for the $500 program deposit. The scholarship will be $1,500. No scholarships are available for students applying for summer programs.

Scholarships are limited in number and are awarded on the basis of financial need and proven academic ability.

Incomplete, late, or illegible forms will not be considered.

Student Certification
I certify that the above information is true to the best of my knowledge.

Signature_______________________________________ Date ________________________

In addition to this form, you will need to submit
1. An essay (minimum 1 page typed, double-spaced) describing your financial need;
2. An essay (minimum 1 page typed, double-spaced) explaining what you hope to gain from study abroad.

Send completed, signed, dated scholarship application form and essays, along with other application materials, to:

Carol de Rosset
Coordinator of International Initiatives, Appalachian College Association
210 Center Street
Berea, Kentucky 40403
Phone: 859-986-1043 or 859-986-4584
Fax: 859-986-9549
E-mail: caroldr@acaweb.org

Go to IFSA-Butler Study Abroad Scholarships Information Page