PSU International Special Programs - Information Request Form

Information Request

To contact the International Special Programs office, please use the form below. This form can be submitted electronically, or printed and faxed.

Fields in red are required; all other fields are optional.

First Name:		Last Name:
Title:
Institution/ Organization:
Email
Address 1 (line1)
Address 2 (line2)
City		State/Province
ZIP/Postal Code		Country
Telephone		Fax
Estimated number of program participants/students:
Estimated age of program participants/students:
Program dates (month/day/year)		from:
		to:

Desired content, classes, topic area(s), language instruction, activities, etc. (please be as specific as possible):
Would a chaperone or group leader accompany the participants? Yes No
If so, how many chaperones or group leaders?
Housing preference: (check all that apply) Dormitory Homestay Combination homestay/dormitory Apartment Hotel
Do you want official PSU academic credit? Yes No
Other special requests:
Desired price range:
Your questions or comments:
How did you hear about PSU's International Special Programs: (check all that apply) Search engine (Internet search) PSU Web site link Link from another Web site Referred by someone you know at PSU or in Portland Referred by a co-worker/colleague at your institution Referred by a friend/aquaintance Other