Student Biographical Information

Students interested in the German Exchange Program must submit the following information to Dr. Sharon VandenHeuvel:

NAME:

ADDRESS:

TELEPHONE NO:

E-MAIL ADDRESS:

FAX NUMBER:

GENDER:

BIRTHDATE:

MARITAL STATUS:

PROGRAM OF STUDY:

ALLERGIES:

DIETARY NEEDS:

MEDICAL CONDITION:

SMOKER:

SPECIAL INTERESTS:

EMPLOYMENT:

EMERGENCY CONTACT PERSON AND TELEPHONE NO:

OTHER:

Send to: Sharon.VandenHeuvel@muskegoncc.edu