Faculty-led Interest form
Let us know where and when you'd like to take your students abroad.
Name
*
First Name
Last Name
WIU email
*
Phone Number
*
-
Area Code
Phone Number
Department
*
Department Chair/School or Program Director/ Supervisor
*
Prefix
First Name
Last Name
Chair/Director/ Supervisor email
*
example@example.com
Destination(s)
*
List the cities and country(s) in your itinerary.
Dates
*
List the dates the group will be abroad
Submit
Should be Empty: