SBUBolivar, Missouri Est. 1878

Application for Participation and Agreement of Understanding for Students Enrolled in Global Engagement Programs

This application is for student participation in one of SBU’s Global Engagement Programs. Application can be filled out and printed from Adobe Acrobat Reader. Application can save the filled fields only with Adobe Acrobat Pro.

  • Students wishing to participate must complete the application and acquire the necessary signatures.
  • All students must fill out Forms 1, 2 & 3 of this application packet. All SBU students must fill out all five forms in this application packet (Form 5 is not required for GCSA-Ecuador).
  • Upon completion of this application and submission of Form 1 and a deposit of $500 to the Office of Global Engagement (The Dean’s Office in the College of Science and Mathematics, Room 100 Wheeler) a student has reserved their place in line.
  • Students will be notified of their acceptance into the Global Engagement Program no later than the Student Acceptance Notification date as specified on the website for the appropriate program and semester of application.
  • Form 1 of the application and the deposit must be submitted by the Application Due date as listed on the website for the semester of interest.
  • The $500 deposit will be refundable to the student through a request in writing (email acceptable) to the office of Dean of the College of Science and Mathematics, up to the date of the deadline for application as specified on the website.
  • The $500 deposit will not be refundable to the student for any reason, other than cancellation of the program by SBU after the deadline for application.


Students must also provide the following to the office of Dean of the College of Science and Mathematics by the deadline for document submission as specified by the website:

  • Forms 2, 3, 4 & 5  as appropriate
  • Non-SBU students must also sign and return the Principles & Expectations Statement provided on the website. All students are required to follow this statement to determine acceptable behavior during all phases of the program.
  • Digital color copy of a recent picture of student. Portraits encouraged.
  • Digital color copy of the student’s passport. Passport must be valid for a minimum of 6 months following the expected end date of the program.
  • Signed Permission Form from personal physician, if required.


The office of Dean of the College of Science and Mathematics will be pleased to assist any students to scan the above documents for submission.

For More information, please contact:
Dr. Perry A. Tompkins,
Dean of the College of Science and Mathematics
1600 University Avenue
Bolivar, MO  65613
Phone:  (417) 328-1488  | Fax:  (417) 328-1658