Italian Immersion Virtual Course Enrollment Application, Summer 2020

University of the Pacific

General Information

Legal first and last name: *

Preferred First Name:

Preferred Pronouns

Pacific email address *

Secondary email address:

I understand that my Pacific e-mail is the primary way through which I will be contacted about this program. I have verified that my Pacific e-mail address above is correct. I agree to check this email regularly and to respond promptly to messages I receive about this program. *

Yes I agree

Phone number (numbers only) *

Date of birth * +

Current Class Standing *

Major: *

Major Advisor (first and last name) *

Second Major

Second Major Advisor (first and last name)

Minor

Minor Advisor (first and last name)

Second Minor

Second Minor Advisor (first and last name)

Students in need of accommodations are advised to contact the Office of Services for Students with Disabilities (McCaffrey Center 116). *

I will contact SSD directly to request accommodations.

I am not in need of accommodations.

How did you hear about the Summer Program? (check ALL that apply) *