University of Southern Maine
Office of International Programs
 
Survey of International Experience & Interest
 
Name:
 
Department:
 
Title:  
 
Campus Address:
 
Campus Phone:
 
E-Mail Address:
 

Please mark the appropriate category:

Full Time Faculty

Part Time Faculty

Full Time Professional Staff


Part Time Professional Staff

Full Time Classified Staff

Part Time Classified Staff
 
Please complete all of the following that apply:
 

1. Have you studied at an educational institution outside of the United States?

Name and Location of the Institution:

Level of Education:

2. Have you taught at a university outside of the United States?

Name and Location of the Institution:

Subject:

3. Do you hold a degree from an International University? If so, please provide the following:

Name of the Institution:

Location of the Institution:

Degree Details:

4. Have you conducted research in an international subject area or in a foreign country?

Subject/ Country
5. Have you collaborated with a colleague who is outside of the United States?

Nature of collaboration:

6. Do you speak a foreign language?

Which language(s) & level of proficiency

7. Do you have a personal interest in a country or geographic area which you wish to explore in the future?

Country or Geographic Area:

Please indicate the nature of your interest:

8. Have you traveled abroad?

Please specify country(s)
9. Have you lived abroad for an extended period of time?

Please specify country(s) & amount of time abroad:

10. If you were not born in the United States, what is your country of origin?
11. Please list any international awards or scholarships that contributed to the funding of your experience abroad: