Welcome to the MBA Program at Fayetteville State University

MBA PROGRAM
APPLICATION FORM
Study Abroad Program – China
May 6-21, 2007

First Name:

Last Name:

Mr. / Mrs. / Ms. / Dr. / Professor

E-mail:

Date of Birth:

Age:

Male / Female

Address:

City:

State:

Zip Code:

Phone (H): ( )

Phone (W): ( )

Cellphone: ( )

Nationality:

Passport No:

Occupation:

Employer:

Total Trip Fee: $2,350
First Payment: $1,350 (by Feb. 28, 2007)
Balance: $1,000 (by April 6, 2007)

Paid by: Certified Bank Check / Money Order/ Personal Check

If you plan to enroll in HCM 695 or BADM 603, please note that the trip cost does not include the tuition fees)

I agree that:
1) The above information is true and documents given in support of my Application are complete and correct.
2) I will abide by the laws of the People's Republic of China and will not engage in activities that bear no relation to the educational objective of this trip.
3) I understand that Fayetteville State University does not bear any responsibility due to personal injury or otherwise during the entire length of this trip.
4) I agree to observe Fayetteville State University’s Terms and Conditions.

Signature of Applicant

Date

Comprehensive information about the Study Aboard Program-China is available at: http://www.uncfsu.edu/mba/studyabroadcn/summer2006.htm.
For general questions, contact Dr. Assad Tavakoli via e-mail atavakoli@uncfsu.edu or telephone at (910) 672-1527.