Counseling Graduate Program- New Orleans.

5/12/2025 - 5/22/2025

This application is not complete until the following item is turned into the Office of Education Abroad in UC 305/859-572-6194 on or before the application deadline of February 24th: 1) a non-refundable deposit of $500 by cash, check, or credit card and

ApplicationModels

Personal Contact Information

First Name

Middle Name

Last Name

Preferred Name

Birthdate (mm/dd/yyyy) Enter Birthdate like so: mm/dd/yyyy

Gender

Home Phone Number

Cell Phone Number

Preferred Email (Check Frequently!)

NKU Email

Current Address

Street

City

State

Zip Code

Permanent Address (Same as 'Current'?)

Street

City

State

Zip Code

Emergency Contact

First Name

Last Name

Relationship to Applicant

Home Phone Number

Cell Phone Number

Regularly Checked Email Address

Address Street

Address City

Address State

Address Zip Code

Special Requirements

Dietary Requirements (i.e. vegetarian, allergies, etc)

Please provide a response. Enter n/a if not applicable.

Other

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How did you hear about this program?

PARTICIPANTS WILL BE FINANCIALLY RESPONSIBLE FOR THE AIRLINE TICKET AND ANY OTHER UNRECOVERABLE EXPENSES INCURRED BY THE OFFICE OF EDUCATION ABROAD ON THEIR BEHALF. PARTICIPANTS MUST NOTIFY THE OFFICE OF EDUCATION ABROAD OF ANY CHANGES TO THE INFORMATION ON THIS APPLICATION.

I have read, fully understand, and agree upon the terms outlined above.

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