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Global Learning > Student Corner > Student Application

Global Learning Student Application

Personal Information
* First Name
* Last Name
Preferred name
Gender	Female Male
Date of Birth (MM/DD/YYYY)
Nationality (ex: USA)
* Please list any health condition(s) that would prohibit you from fully participating in this course. Please include serious allergies.
Passport Information Please provide information on your passport
Name as it appears on passport
Passport #
Passport Expiration Date (MM/DD/YYYY)
* If you do not have a passport, when do you expect to receive yours?
Student Information Please provide information about you as a student.
Lipscomb ID (L#)
Mobile Number
E-mail Address
Hours Earned
Current Cumulative GPA
Parent/Guardian Address & Emergency Contact Provide your permanent address information and emergency contact information.
Address
City
State/Province
Zip/Postal Code
Country
Home Phone
Emergency Contact's Name
Relationship
Phone Number
E-mail
Traveling Abroad
* Please select a program
If other, please provide trip name and time period
Why are you interested in the above program?
Have you traveled outside the U.S.? If so, where and how long?
Commitments & Expectations
My deposit will be non-refundable unless Lipscomb University has to cancel the program.
* I understand.
Substantial expenses will be incurred on my behalf to purchase program related items. Should I withdraw from the program I will reimburse the university for any cancellation expenses and non-refundable costs.
* I understand.
Your application and non-refundable deposit represents your acknowledgment of and agreement to the following commitments and expectations: Respect for the culture and customs of the countries you visit. Behavior that honors the code of conduct of Lipscomb University at all times. Full participation in all preparatory meetings and activities. Signed Program Agreement and submission of all paperwork required on or before the deadline. A flexible and humble spirit and an interest in learning from the people and culture you encounter.
* Type both words below, separated by a space. Can't read the words below? Try different words or an audio captcha.

Lipscomb University Office of Global Learning
One University Park Drive Nashville, Tennessee 37204
global.learning@lipscomb.edu | 615-966-2100 | Lower Level of Johnson Hall

Global Learning Student Application

Personal Information

Passport Information

Student Information

Parent/Guardian Address & Emergency Contact

Traveling Abroad

Commitments & Expectations