2021 Student Application Form General InformationName* First Middle Last Other Name (i.e. maiden, former, preferred...)Preferred pronoun*he/himshe/herthey/themotherAre you a US citizen/permanent resident?*YesNoIf no, please specify nationalityEmail* Current Phone Number (domestic)Required for applicants from within the United States.Current Phone Number (international)Required for applicants from outside the United States.Current Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Current address effective until Date Format: MM slash DD slash YYYY Education & Employment InformationAre you currently a student?*YesNoIf yes, answer next four questions:School currently attendingCurrent Degree ProgramBachelor'sMaster's (terminal)Master's/PhDPhDOtherDiscipline/MajorExpected Graduation Date (month/year)Are you applying to any degree programs for Fall 2021?*YesNoIf yes, please list the degree programs and schools you are applying to.Current job title (non-students)Place of occupation (non-students)All applicants to SEASSI must submit a transcript from your current university (if applicable) and every college/university you have attended (Note: SEASSI transcripts are not needed). We will accept official transcripts or scans of official transcripts. Please list below the colleges and universities you have attended, separated by commas (School 1, School 2, ...)*Financial AidAre you interested in applying for financial aid?*YesNoIf yes, what awards are you applying for? Please check all that apply. FLAS Fellowship (apply by February 15, 2021) SEASSI Tuition Scholarship (apply by April 5, 2021) Please note that fellowships and scholarships have their own eligibility requirements, which you can find here.Recommender #1 name (if applying for financial from SEASSI)Recommender #1 email (if applying for financial from SEASSI)Recommender #2 name (if applying for financial from SEASSI)Recommender #2 email (if applying for financial from SEASSI)Have you applied for other scholarships/awards to support your studies at SEASSI?*YesNoIf you know you will be recieving a scholarship to attend SEASSI, please specify name of award and the amount of funding.Language InformationWhich language do you wish to study at SEASSI?*BurmeseFilipinoHmongIndonesianJavaneseKhmerLaoThaiVietnameseIf you do not see your desired language, please contact us at seassi@seasia.wisc.edu.Which level do you anticipate studying at SEASSI 2021?*First YearSecond YearThird YearNote: Placement tests will be given to everyone on the first morning of classes.If you have previously studied this language, please let us know: where you studied, textbooks used, duration of study.Have you previously attended SEASSI?*YesNoIf yes, please list the summer(s) you attended and language(s) studied.Are you ONLY able to attend SEASSI as a distance education student?*YesNoNote: The offering of distance classes will depend on sufficient enrollments. Distance students will be admitted based on inability to attend SEASSI in person and access to adequate computer equipment and internet speed. If you mark “Yes” to the above question, SEASSI staff will contact you to evaluate the feasibility of your participation as a distance student. Attendance as a distance student may affect your eligibility for the FLAS Fellowship award.Application Materials ChecklistPlease fill in the following list of materials that we should expect to receive from you. Non-refundable application fee of $25 – all checks or money orders should be made payable to SEASSI. (Please do not send Western Union or any other money transfers.) Personal Statement of career/academic plans (approx. 1-2 pages) Transcripts Letters of Recommendation (if applying for financial aid) Application materials may be sent separately or together via email to seassi@seasia.wisc.edu, or via hard copy to: SEASSI, 207 Ingraham Hall, 1155 Observatory Drive, Madison, WI 53706. Note that the application fee must be sent via check or money order payable to SEASSI.