Full Name (Required)

e-mail (Required)

Address

Address 2

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What type of international experience do you want to participate in? (Required) Academic/Study Abroad  Foreign Language  Home stay  Internship  Professional Development  Research Project  Teach Abroad  Volunteer Abroad

Where do you plan to go for your international exchange experience? (Required)

What do subjects or topics do you want focus on Anthropology Arabic Art Biology Cantonese Chemistry Communications Community Development Ecology English Film French Foreign Language German Health Care Japanese Mandarin Medicine Photography Spanish Social Work Other

What is your disability? ADD AD/HD Amputee Arthritis Asperger's Syndrome Autism Blind Chronic Health Condition Cognitive Disability Deaf Deaf/Blind Diabetes Hearing Impaired Learning Disability Mental Health Paraplegic Quadriplegic Traumatic Brain Injury Other

I would like a peer who has used the following reasonable accommodations/equiptment while abroad Augmented Communication Device  Braille  Cane  Crutches  Extra time  Guide Dog/Service Animal  Laptop Computer  Large Print  Manual Wheelchair  Medications  Note Taker  Oxygen  Personal Assistant/Attendant  Power Scooter  Power wheelchair  Prosthesis  Sign Language Interpreter  Transliterator  Ventilator  Walker/Rollator  Walker/Rollator  White Cane  Other

If you checked Other please describe what you need (Required)

Do you need information sent to you in an alternative format? Braille  Large Print  Electronic text  Cassette Tape