Latin American Studies Semester Application

Latin American Studies Semester Application

Spring 2023
Name *

First Name Last Name
What are your preferred gender pronouns? *

She/her/hers He/him/his They/them/theirs
Mailing Address (during spring semester) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cell Phone Number *

Area Code Phone Number
Temple Email Address *
example@example.com
TUid Number *
Major *
Minor *
College *
Names of your past and current Spanish instructors at Temple: *
College Year of Study *

Freshman Sophomore Junior Senior Graduate
If you are in your first year at Temple, either as a freshman or transfer student, please indicate the name and email addresses of an additional professor, from any discipline who could serve as a reference. A letter of recommendation is not required.
Passport *

I have a valid passport I have applied for a passport I have provided a copy of the passport or application
Spanish Educational Background (list course titles/numbers from college and high school) *
List most recent Spanish course taken at Temple University (include date) *
List other courses taken in Spanish, Foreign Languages, and Literature *
Foreign Travel: Indicate countries you have visited, year, length of stay, and purpose *
Describe additional exposure to Spanish (e.g. at home, community, work, etc.) *
Why do you want to participate in the LASS program? *
Current GPA *
Please review the Eligibility and Application Requirements. Do you understand the intensive nature and special requirements of the LASS program and agree to comply with these requirements? Any student with 5 or more absences or an average of 69 or below in SPAN 2098 or another of the LASS courses before the departure of the study trip will not be permitted to travel with the group as part of Temple University and will not receive a refund for fees paid. Students will complete work in lieu of the study trip. *

Yes No
RELEASE OF INFORMATION REGARDING DISCIPLINE

You, the undersigned participant, agree to provide this Release of Information Regarding Discipline in consideration of your application to participate in the Latin American Studies Semester Program (the “Program”) offered by the Department of Spanish and Portuguese (the “Department”) at Temple University (“Temple”). You release Temple’s Office of the Dean of Students to inform the director and administrators of the Program of any disciplinary charges filed against you, code violations involving you, or any other information regarding you on file with Temple’s Department of Student Conduct and Community Standards. You understand that participation in the Program is voluntary and that, because of the sensitivity of off-campus travel, any information provided by Temple’s Department of Student Conduct and Community Standards may be used in determining your eligibility to participate in the Program. Intending to be legally bound hereby, you, on behalf of yourself as well as your minor children (if any), assigns, and legal representatives, hereby expressly agree to release your disciplinary record to the Department. You make this release understanding your right to prevent disclosure of information from your educational records under the United States Family Educational Rights and Privacy Act of 1974. You, the undersigned participant, expressly acknowledge that you have read and understand this Release of Information Regarding Discipline and sign it freely and voluntarily.
Participant Electronic Signature: Please enter your name and today's date. *
Date

Month Day Year
Date
Parent/Guardian Electronic Signature (if Participant is a minor): Please enter your name and today's date.
Date

Month Day Year
Date
Should be Empty: