STUDENT APPLICATION GUIDELINES

for

STUDY ABROAD

The following study abroad application is designed to help you take the first step toward participation in a successful and educationally rewarding study abroad experience.  Please read the guidelines and application materials carefully.  Fill out the application completely and accurately.  If you have any questions, contact the Study Abroad Office, in Hinsdale Hall 137, ext. 5160.

FIRST-YEAR STUDENTS

First-year students may participate only during the spring three-week session with the permission of their advisor and the Associate Dean of the College.

GPA REQUIREMENTS

All applicants must have a minimum GPA, as designated in the chart below, for acceptance into a program.  The Study Abroad Office reviews GPAs of all applicants at the end of each semester.  Once an applicant is accepted to a program, this minimum GPA must be maintained.

PASSPORTS

Students who are U.S. citizens should apply for a passport well in advance of the departure date allowing a minimum of three months for passport and visa processing.  Passport application forms and passport photos are available in the Study Abroad Office.  Once you have your photos and have completed the application, you must make an appointment at a passport application location.  For application locations go to http://iafdb.travel.state.gov/.  Requirement instructions on what you need to take with you when applying is found on the back of the application.  A student already in possession of a U.S. passport/green card must be certain that these documents do not expire within six months of the date of return to the U.S.

Students holding passports from countries other than the U.S. should notify the Study Abroad Coordinator at the time they are accepted into the program.  This will allow enough time to obtain the required visas in advance of departure.

RECOMMENDATIONS

Two of your three recommendations must come from Hiram faculty members who have taught you.  The third may come from another member of the Hiram Community such as an employer.  Students may be accepted into a program only after all completed recommendation forms are received in the Study Abroad Office.

FINANCES

When you are officially accepted into the program and have registered for the course(s), your account will be charged the entire cost of the trip. The refund policy is attached to this application. All students participating in a program must have their study abroad charges paid in full or have arranged a payment plan approved by the Business Office prior to departure for the trip.  Information related to loans for Study Abroad Programs can be obtained by contacting Student Financial Services at 330-569-5107.

A Charles McKinley Scholarship is available to one junior or senior student going on a study abroad trip in the fall and one in the spring.  The Study Abroad Office will notify all students by e-mail the deadline dates for applying to this scholarship.

ORIENTATION MEETINGS

Students must submit all required forms, attend all orientation meetings, and complete all academic work related to the trip by the established deadlines. Failure to do so may result in removal from the trip. Students removed from a trip will incur any cancellation costs (see refund policy attached).

GUESTS

A spouse/parent is not permitted to accompany a student on a study abroad trip unless the spouse/parent is a Hiram College faculty member.

WITHDRAWAL FROM A STUDY ABROAD COURSE/PROGRAM

Prior to program departure, any student wishing to withdraw from a study abroad course(s) must complete a “Trip Withdrawal Form” in the Study Abroad Office, in addition to withdrawing from the course(s) in the Registrar’s Office.  Since the dynamic of a study abroad trip is different than that of an on-campus course, once the trip has begun a student may withdraw a course(s) only with the permission of the faculty leader and the Associate Dean of the College.  If a student withdraws from a study abroad trip after the deadline stated in the acceptance letter, the student forfeits the unrecoverable expenses incurred as a result of the cancellation. Note:  see refund policy attached to this application.

STUDENT RESPONSIBILITIES

Each student planning to participate in a study abroad program will be expected to:

• Maintain an appropriate GPA as identified on the Application for Study Abroad
• Provide complete and accurate information on the study abroad application
• Follow-up with faculty to insure that recommendations are sent to the Study Abroad Office in a timely manner
• Complete all coursework and submit all required forms (including health, waiver and release, and beneficiary, and a copy of the passport, and travel plan) by the designated deadlines
• Present documentation of health insurance in effect at the time of the trip
• Obtain valid passport, visas and student ID prior to departure
• Attend all orientation meetings and complete all course work as required prior to trip departure
• Be respectful of faculty leaders, student colleagues, and peoples and cultures of the host countries while abroad

HIRAM COLLEGE

APPLICATION FOR STUDY ABROAD

Please read the instructions carefully and seek assistance if you have any questions.  Complete this form, the Student Waiver and Release Agreement, and the top portion only of the recommendation forms and return the forms along with the completed Parent/Guardian Waiver and Release Agreement to the Study Abroad Office in Hinsdale Hall 137. The Coordinator will forward the recommendation forms to the faculty and staff you have designated for them to complete.  A non-refundable $75 application must be paid upon submitting your application or paid to the Business Office prior to submitting your application (Please attach receipt to your application).  You must have your study abroad program charges paid in full or have arranged a payment plan approved by the Business Office prior to departure for the trip.  Students withdrawing from the trip after acceptance will follow the Study Abroad Refund Policy.

TODAY’S DATE_________________________

PROGRAM LOCATION: ___________________________________________________ Expected Graduation Year: ____________

STUDENT NAME:  ______________________________________________ _______________    Current Status:  (F)  (So) (J) (Sr)    

                                                    (Please print as it will or currently appears on your passport)                                         

GPA:  ________   MAJOR:      _____________________________ Banner I.D.#:_____________________ BIRTHDATE:  _________

CAMPUS DORM and ROOM #:__________________________________ CAMPUS PHONE:_________   Hiram P.O. Box:___________

WEC____TRADITIONAL____ If you are residing off-campus, what are the best ways and times to reach you (email, voice mail, other)?___________________________________________________________________________________________________________

OTHER ADDRESS:  _______________________________________________________________________________________    

                                                      (Address where you can be reached when school is not in session, or if you do not live on campus)                                                                   

Cell Phone:______________________________________________________Home Phone:_____________________________________

MEDICAL INSURANCE COMPANY:  ______________________________ POLICY #:      _____________________________________

     Please attach a copy of the front and back of your health care insurance card.  (If you have a medical condition that might affect your

     participation in a study abroad program, discuss this with the Study Abroad Coordinator in the Study Abroad Office.) 

HAVE YOU PARTICIPATED IN A PREVIOUS HIRAM COLLEGE STUDY ABROAD PROGRAM?

     YES____NO____ If yes, which one(s):  ______________________________________________________________________

                                                                              (If yes, the leader(s) of that program may be contacted)

LIST NAMES OF THREE REFERENCES, INCLUDING YOUR ACADEMIC ADVISOR:

     ACADEMIC ADVISOR: ________________________________________________________________________________________   

     NAME:  ______________________________________ POSITION: ___________________________________________________

     NAME:  ______________________________________ POSITION: ___________________________________________________

PERSON TO NOTIFY IN CASE OF EMERGENCY:

________________________________________________________________________________________________________________

Name                                                                                                             Relationship to You

________________________________________________________________________________________________________________

Street Address

  ______________________________________________________________________________________________________

City                                                                                      State                                                    Zip Code

  ______________________________________________________________________________________________________

Home Telephone                                                                                              Work Telephone

Applicant’s Signature_______________________________________________________________Date___________________________

POLICY REGARDING BEHAVIOR AND ACADEMIC PERFORMANCE:

Given that the nature of a study abroad trip differs from on-campus work, acceptance into the program implies that students will complete all courses undertaken in the program.  In addition, faculty members leading a study abroad program have the right to dismiss from the program anyone whose behavior or academic performance falls below the standards of Hiram College.  If such action becomes necessary, the faculty member(s) will notify the Study Abroad Office.  All costs for the program, along with any additional costs that result from this type of action, will be the responsibility of the student.

ACCESS TO BEHAVIOR AND MENTAL STABILITY RECORDS:

The Study Abroad Office submits the names of students who intend to study abroad to the Coordinator of Citizenship Education, Director of Residential Citizenship & Commuter Education, Director of Counseling and Disability Services, and Director of Health Center in order to ascertain whether there have been any disciplinary, behavioral, or other problems involving all study abroad participants.                                      

LIMITATIONS OF RESPONSIBILITY:

Hiram College and its agents use their best efforts to arrange travel accommodations and related services; they shall not be held responsible for any injury, loss, accident, illness, delay, or irregularity of incident; nor shall they be held responsible for any act or omission of any individual or organization which has undertaken to provide transportation, service or accommodations in connection with these arrangements, nor for any delay or expense incurred. 

NOTICE:   GPA POLICY FOR STUDY ABROAD TRIPS

The Study Abroad Board has established a policy that all students applying for Study Abroad trips must have a minimum GPA for acceptance into a program.  This policy is designed to ensure that all applicants will have above a 2.5 average and not be on academic review at the time they begin participation in a Study Abroad program.  Our overall goal is to increase accessibility of Study Abroad programs for all serious Hiram College students.  

The Study Abroad Office reviews GPA's of all applicants at the end of each term.  Once an applicant is accepted, this minimum GPA must be maintained or students will be placed on a waiting list.  We encourage students with problematic GPA's to contact the Study Abroad Office to determine how they can increase the likelihood that they will be accepted for a Study Abroad program.

GPA requirements are listed below:

MY PARTICIPATION IN THIS EDUCATIONAL TRAVEL PROGRAM SHALL CONSTITUE MY ACCEPTANCE OF THE POLICIES REGARDING BEHAVIOR AND ACADEMIC PERFORMANCE, LIMITATIONS OF RESPONSIBILITY, AND GPA.

I intend to finance my trip by:              ?  borrowing additional educational loans

                                                                        ?  paying cash

                                                                        ?  parental contributions

                                                                        ?  combination of methods

                                                                        ?  other:________________________________________________________________________________

                                                                        ?  I don’t know; I will make an appointment with the Financial Aid Office ASAP

Applicant’s Signature _____________________________________________________________________ Date __________________________

Study Abroad Office

Hinsdale 137, P.O. Box 67

Hiram, OH 44234

Phone: (330) 569-5160, Fax: (330) 569-5381

HEALTH INFORMATION

Name ________________________________________________ Birth Date ________________ Gender              

Program ______________________________________________ Banner ID #  _____________________

It is important that all participating representatives of Hiram College be made aware of any medical or emotional problems, past or current, which might affect you in a foreign study context. Mild physical or psychological disorders can become serious under the stresses of life while studying abroad.  The College may not be able to accommodate all individual needs or circumstances.

Yes q No q   1. Are you prepared to meet the physical demands of this study abroad program?

Yes q No q   2. Have you ever been treated or are you currently being treated for any psychological or emotional problems? (If yes, please explain.)

Yes q No q   3. Do you have any allergies and/or have you had allergic reactions to medications? (If yes, please explain.)

Yes q No q   4. Are you taking any medications (prescription or over-the-counter)? (If yes, please explain.)

Yes q No q   5. Have you had any major injuries, diseases or ailments in the past five years? (If yes, please explain.)

Yes q No q   6. Are you a vegetarian or are you on a restricted diet? (If yes, please explain.)

Yes q No q   7. Is there any additional information (concerning medical conditions or physical disabilities) that would be helpful for Hiram College faculty and staff participating on the program to be aware of during your study abroad experience? (If yes, please explain.)

Yes q No q   8. Do you have special housing needs? (If yes, please explain.)

I certify that all responses made on this Health Information form are true, accurate, and complete and I will notify the College hereafter of any relevant changes in my health that occur prior to the start of the program.

Signature of Participant ________________________________________________ Date ­­­­­­­­­­­­­­_________________________

STUDENT WAIVER AND RELEASE AGREEMENT

I, _____________________________________, am a student at Hiram College and desire to participate in the College’s study abroad program in ____________________________________, from____________ until ______________.  In consideration for being permitted to participate in the Program, I understand, agree, represent, and warrant that:

• A non-refundable $75 application fee must accompany your application or be paid prior to submitting your application.   I understand that I must have study abroad charges paid in full or have arranged a payment plan approved by the Business Office within 30 days of receiving my billing statement.  If I withdraw from a trip after being accepted, I will refer to the Study Abroad Refund Policy attached to this application.

• The Study Abroad Office submits the names of students who intend to study abroad to the Dean of Students in order to ascertain whether there have been any disciplinary, behavioral, or other problems involving these students.

• The College reserves the right to remove me from the Program at any time should my actions or general behavior, as determined by the sole discretion of the College, fail to be consistent with Hiram College policy or be determined to impede or obstruct the progress of the Program in any way.  Should such action become necessary, I will be charged for all my costs for the program, along with any additional costs that result from my behavior.

• My acceptance into the program requires that I complete all courses undertaken in the program and maintain satisfactory academic progress toward my degree.

• I have or will secure health insurance to provide adequate coverage for any injuries or illnesses that I may sustain or experience while participating in the Program.  By my signature below I certify that I have confirmed that my health care coverage will adequately cover me while outside the United States, and hereby release the College, and its employees from any responsibility or liability incurred by me for injuries or illnesses (including death) that I may incur because of those injuries or illnesses.

• Although the College will attempt to maintain the Program as described in its publications and brochures, it reserves the right to change the Program, including the itinerary, travel arrangements, or accommodations, at any time and for any reason, with or without notice, and that neither the College, nor its employees or agents, shall be responsible or liable for any expenses or losses resulting from these changes.

• Although the College makes reasonable efforts to assure my safety while participating in the Program, there are unavoidable risks in travel overseas, and I hereby release and promise not to sue the College, or its employees and agents, for any damages or injury (including death) caused by, derived from, or associated with my participation in the Program, except for such damages or injury as may be caused by the gross negligence or willful misconduct of the employees or agents of the College.

• Should any provision or aspect of this agreement be found to be unenforceable, all remaining provisions of the agreement will remain in full force and effect.

• My agreement to these provisions is wholly voluntary and, prior to signing this agreement, I have had every opportunity to consult with an advisor, counselor, or attorney of my choice.

• Any legal dispute concerning my participation in the Program shall be conducted in the Ohio courts and governed by Ohio law.

• This agreement represents my complete understanding with the College concerning the College’s responsibility and liability for my participation in the Program, supersedes any previous or contemporaneous understandings I may have had with the College on this subject, whether written or oral, and cannot be changed or amended in any way without my written concurrence.

• I am at least eighteen years of age or, if not, I have secured below the signature of my parent or guardian signifying acceptance of this agreement on my behalf.              

____________________________________                                                  ________________________________

Signature of Student                                                                                                               Date

____________________________________                                                  _________________________________

Signature of Parent/Guardian (if required)                                                                           Date

PARENT/GUARDIAN WAIVER AND RELEASE AGREEMENT

In conducting academic programs, Hiram College makes reasonable effort to protect the welfare and safety of the participants.  However, Hiram cannot assume responsibility for damage to or loss of property, personal illness or injury, or death while a participant is on the program, nor can Hiram assume responsibility for the actions of participants. We therefore require each applicant and his/her parent or guardian to sign the following statement as an indication that this position is understood and accepted.

I certify that I am the parent or legal guardian of Student, _______________________________­____________,

who is a participant in the Hiram College Study Abroad Program.  I also certify that the Student will be participating in the study abroad program with my full knowledge and consent.  I have read the agreement and waiver signed by the student (on the reverse of this sheet), and I understand and agree to its provisions on behalf of the student.

.

I hereby release and forever discharge the College, its officers, directors, employees, trustees, agents, representatives, insurers, administrators, successors and assigns, of and from any and all liability of any kind or character whatsoever to me or my heirs, successors or assigns with respect to any act or omission by the College with respect to the participation of the Student in the Program.

I further agree that I will indemnify, defend and hold harmless the College, their officers, directors, employees, trustees, agents, representatives, insurers, administrators, successors and assigns from any and all claims of any nature whatsoever made by anyone which in any way arise out of, or result from, the negligent or alleged negligent acts of the Student.

I have read and understand the terms and conditions of this Agreement, Indemnification and Release, and I agree and subscribe to them.  My signature below also signifies that the Student has sufficient health, accident, disability and hospitalization insurance to cover him/her during participation in the Program, and that I expect and recognize that none of the fee paid for this Program goes toward the payment of such insurance, and that the College has no obligation to provide any insurance related to the Student.

___________________________________                                _____________________________

Signature of Parent/Guardian                                                               Date

Printed Name _________________________________________________________________

Address ______________________________________________________________________

Study Abroad Program brochures are available upon request by contacting:

Study Abroad Coordinator

Study Abroad Office

Hinsdale 137

Hiram College

330-569-5160

STUDY ABROAD RECOMMENDATION FORM

STUDENT SECTION:  Complete this top section only and return the form to the Study Abroad Office, Hinsdale 137.  The Study Abroad Office will forward the form to the faculty for completion.

NAME:  ________________________________________________________________________

PROGRAM FOR WHICH YOU ARE APPLYING:  ______________________________________

PERSON YOU WISH TO HAVE COMPLETE THIS RECOMMENDATION:  __________________              

Under the provisions of the Family Educational Rights and Privacy Act, I  (check one) waive q   retain q the right of access to this recommendation.

Student Signature                                                                                                                                                        Date

RECOMMENDER’S SECTION

Please complete and return this form via campus mail to the Study Abroad Office (Hinsdale Hall 137) as soon as possible. If this completed form is not received in the Study Abroad Office prior to the application deadline, it will jeopardize the student’s selection for a study abroad program. You may use the reverse of this page or attach an additional sheet as necessary.

The above student is applying to participate in a Hiram College study abroad program. Because living and studying in another culture can increase pressures on a student, it is important to know as much as possible about each applicant. 

1. How long have you known this student  ___________________________________________

1. In what capacity?  __________________________________________________________

1. What is your general estimate of the applicant’s intellectual ability and motivation?

1. How did this student relate to colleagues in class or at work?

1. How has the student demonstrated qualities including the emotional maturity, stability, flexibility, and open-mindedness that would lead you to believe that the student could adjust socially and personally to study and travel abroad?

1. What difficulties might the student encounter on this trip?

1. Please add any other comments you may have about this student’s qualifications or suitability for this program (on back).

 Signature                                                                                                               Date                                               Phone

Hiram College Study Abroad Refund Policy

                   Study Abroad programs require extensive, detailed advanced planning on part of faculty and  Study Abroad Office.  Because commitments for flights, hotels, cooperating agencies and organizations are frequently done months in advance of the trip, it is essential that students be aware of the financial commitments when signing up for a program.  Likewise, the College is sensitive to extenuating and unforeseen circumstances that arise in students’ lives that could make it impossible for a student to meet the travel commitment.  Thus, the College has established a policy whereby both the College and committed students incur the least financial penalty for change of plans. 

°        Hiram College study abroad trips will be included on the initial billing for the semester in which the trip takes place.

°        The cost of the trip is to be paid in accordance with the Hiram College payment policy.

°        Withdrawal from a Hiram College sponsored study abroad trips must follow the Study Abroad Withdrawal Policy, as well as change in course registration.

°        Refunds for withdrawal from a study abroad trip will be a percentage (%) of the amount charged for the trip.  Costs incurred by the College, such as airfare, hotel, in country transportation and similar will reduce the amount refunded.

°        Any credit the student received from the College for room or board will be added back to the student’s bill and payment is due by the next scheduled payment date.

°        Any refund will be applied directly to the student bill.

°        The % refunded will be on the following basis (the amount refunded after the % calculation will be reduced for any costs incurred by the College)

                    •         75% of the trip billed will be refunded if dropped by the1st Hiram College payment plan due date for the semester.

                    •         50% of the trip billed will be refunded if dropped by the 2nd Hiram College payment plan due date for the semester.

                    •         25% of the trip billed will be refunded if dropped by the 3rd Hiram College payment plan due date for the semester  

                    •         0% of the trip billed will be refunded if dropped after the 3rd Hiram College payment due date for the semester.

                                        •         If a student fails to withdraw from a study abroad trip, there will be 0% refunded

                              •     Once a study abroad trip departs, there will be 0% refunded for cancelled participation