Last Name *


First Name *


Middle Initial


Date (mm/dd/yyyy)


Semester, applying for
- Fall 2010 Spring 2011 Both, Fall 2010 and Spring 2011

Summer Session, applying for
- May Session June Session July Session Both, June and July Sessions

Indicate your intended course of studies


Gender
M
F

Date of birth (mm/dd/yyyy) *


Social Security Number or National Identity Number


Permanent Address (All mail correspondence will be sent to this address) *


City *


State *


Zip Code *


Country *


Phone Number *


Cell Number *


Email address *


Would you like to receive Maryville University credit
Yes
No
Unsure

Would you like to receive a SRISA transcript (1)
Yes
No

Do you plan to arrange housing through SRISA
Yes
No

How did you learn about SRISA
- Website Poster Study Abroad Office Other students Teachers Internet Study Abroad Search Engine (i.e. studyabroad.com) Other

Please, check the box that best describes your ethnicity (2)
- African American Asian Hispanic Native American White, Anglosaxon Other

Please, explain your previous art experiences


What school, if any, will you be returning to at the end of the program? *


Have you traveled to Italy before? If so, when?


What do you hope to gain from this program?


Address you would like your Housing Deposit returned to *


Do you have any physical conditions, limitations, or allergies we should know about?


Indicate Your First Housing Choices *
- Double room in a shared apartment Single room in a shared apartment Private Apartment Arrange your own housing

Indicate Your Second Housing Choices (3) *
- Double room in a shared apartment Single room in a shared apartment Private Apartment Arrange your own housing

Indicate Roommate/s Preference (4)


Do you Smoke?
Yes
No

Are you willing to share an Apartment with smokers?
- Yes No Doesn't matter

Are you willing to share a co-ed Apartment?
- Yes No Doesn't matter

I like to go out every night
- Yes No Sometimes

I like to cook meals at home
- Yes No Sometimes

Describe your ideal roommate, step one
- Likes to keep the apartment and living spaces clean and in order Is laid back and doesn’t mind if things get a little messy sometimes Is like me and doesn’t have time to cleanup and doesn’t mind the mess

Describe your ideal roommate, step two
- Likes to stay out late and party on weekends and weeknights Likes to stay out late and party but only on the weekends Likes to stay home and go out occasionally, but never too late

Describe your ideal roomate, step three
- Likes a quiet, studious atmosphere Likes a high energy and active atmosphere Wants to spend weekends traveling as much as possible

What adjectives would best describe you?


Would you like to tell us anything else about yourself?


Private Apartments: Please fill this out if you have requested a private apartment as your first or second choice. Indicate Your Price Range per month for a Private Apartment


Indicate how many beds/ bedrooms you will need


Indicate those persons sharing an apartment with you


Other specific requests (5)