Student Information

Thank you for your interest in the Peralta Study Abroad Programs. Filling out this form does not guarantee your space in the program. Please contact individual program instructors for payment deadlines and application procedures.

Prior to departure, each student will need to complete the following items:

 1. Complete this online pre-travel information form along with specific program application
 2. Apply for a Passport (if you do not have one already)
 3. Purchase travel insurance (if it is not already included in the cost of the trip)
 4. Sign Assumption of Risk/ Waiver forms
 5. Agree abide by the student code of conduct
 6. Enroll into the PCCD course associated with the trip
 7. Attend mandatory pre- departure orientations
 8. Make payments by deadlines as listed on program information
 9. Obtain proper immunizations as listed on program information
      website (https://www.cdc.gov/)
 10. Register with the US Department of State's smart Traveler Enrollment Program (STEP)- https://step.state.gov/step/

Which Study Abroad Program are you interested in attending?

Question Title

* 1. Which Study Abroad Program are you interested in attending?

Name

Question Title

* 2. Name

Email Address

Question Title

* 3. Email Address

Phone Number

Question Title

* 4. Phone Number

Student ID Number (If available)

Question Title

* 5. Student ID Number (If available)

Date of Birth

Question Title

* 6. Date of Birth

Date
Age at the time of travel

Question Title

* 7. Age at the time of travel

Gender

Question Title

* 8. Gender

Do you have a valid Passport?

Question Title

* 9. Do you have a valid Passport?

If yes, what is your name as it appears on your passport?

Question Title

* 10. If yes, what is your name as it appears on your passport?

What is your current major of study?

Question Title

* 11. What is your current major of study?

PCCD Academic Goal

Question Title

* 12. PCCD Academic Goal

Is this your first class taken at Peralta Community College District?

Question Title

* 13. Is this your first class taken at Peralta Community College District?

What Peralta College do you take most of your classes at?

Question Title

* 14. What Peralta College do you take most of your classes at?

Are you a student enrolling from another college?

Question Title

* 15. Are you a student enrolling from another college?

How did you hear about this study abroad program? (Please click all that apply)

Question Title

* 16. How did you hear about this study abroad program? (Please click all that apply)

T