Santa Barbara City College Study Abroad Program Application Procedures Indonesia Spring Semester 2019

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1 Santa Barbara City College Study Abroad Program Application Procedures Indonesia Spring Semester 2019 Deadline for Application: October 26, Apply early as the number of places in the program is limited and the program may fill before the deadline. Applications may be accepted after the deadline if space is available. This application is for participation in the Indonesia Spring Semester 2019 Study Abroad Program only. To apply to the program, please submit the following: Application form. If you change addresses after submitting your application, please provide the Study Abroad Office with your new address. Unofficial Transcript. Please submit your high school transcript if this is your first semester at a college or university. Responses to Questions (typed or printed clearly). Please answer the questions that are listed on the back of the application form. Paragraph format is acceptable. Two 2 x 2 photos. Two recent photos that are a full-face view are acceptable. Please trim them to fit. Pictures from a passport service or a photo booth are acceptable. Print your name with a ballpoint pen on the back of each picture and staple the pictures in the box on the application form. Completed Student Conduct Release Form (included in this application). The top of this form is to be completed by you and taken to your College s Official responsible for student discipline. At SBCC, that is the Dean of Student Affairs at the Student Services Building, Second Floor, Room SS-260. The bottom of the form will be completed by the appropriate school Official and returned to the SBCC Study Abroad Office. Your acceptance to the program is not final until the form is returned to the Study Abroad Office. Two completed Recommendation Forms (included in this application). At least one of the recommendation forms must be completed by an instructor preferably an SBCC instructor if you are an SBCC student. The second form may be completed by a person who knows you well, such as an employer, supervisor, or a long-time family friend. Please no recommendations from relatives, roommates or boy or girl friends. The recommendation forms can be mailed by the individuals who complete them on your behalf. $250 Non-Refundable First Payment. Payment may be made by check or money order made out to SBCC Spring 2019 Indonesia Program. Please put your check or money order in an envelope and staple it to your application. We do not accept cash. Submit your application. Applications should include the application form, answers to the four questions, two photos, and your deposit check. Incomplete applications will not hold a space in the program. Drop off your application at the SBCC Study Abroad Office, International Education Center, Room 1, or mail your application to: Santa Barbara City College Study Abroad Office 721 Cliff Drive Santa Barbara, CA Interview. After receipt and review of your application, you will be contacted to arrange an interview with the program director. For applicants not living in the Santa Barbara area, interviews can be completed by phone. Notification of Acceptance by SBCC. Nicole Walther, Senior Program Assistant, will notify you of your acceptance by SBCC to the program after your interview and after a review of your complete application documents. Communication. The SBCC Study Abroad Office will communicate with you by and regular mail. We will be using your SBCC PIPELINE e- mail for primary communication if you are enrolled at SBCC. If you change your mailing address or , please notify the Study Abroad Office immediately by sending your new information to nwalther@pipeline.sbcc.edu Santa Barbara City College Study Abroad IEC Room Cliff Drive Santa Barbara, CA Phone: (805) NWalther@pipeline.sbcc.edu Program Director Michelle Paddack mjpaddack@sbcc.edu (805) x4128

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3 Santa Barbara City College Study Abroad Program Indonesia Spring 2019 Program Application Form Legal Name: Last First Middle (as it appears on passport) Current Address: Street Apt. or Box No. City State Zip Alternative Address (after current semester ends.) Street Apt. or Box No. City State Zip Phone # Please provide number best to reach you during the application process & prior to the program start 1. Using a ballpoint pen, print your name and SBCC Indonesia SP19 on the back of the photos. 2. Staple two 2 x 2 size photos here Alternative Phone # (after current semester ends.) Please indicate the best times to reach you at the current phone: Date of Birth: Citizenship (country) Ethnicity Which institution do you currently attend? If SBCC, K# SBCC Pipeline (or primary) address: Please print CLEARLY this is our primary form of communication with you. Secondary Address: Please print CLEARLY this is our alternative form of communication with you until you have a Pipeline address Yes, I would like to get on the group flight No, I m planning to purchase my own roundtrip flight Academic Major What is your academic goal? (I.e. Transfer with AA,) Please list the names of two people who may be contacted in the event of an emergency. These people may be parents, guardians, relatives, or close friends. Name: Address: City, State, Zip: Phone: Relationship: I hereby authorize SBCC representatives to contact and discuss with the persons listed above my status in the study abroad program. I further authorize Carola Smith, Senior Director of International Programs, to review my student conduct file. Signature: Date:

4 Check here if you would like to request special accommodations. If you have a disability for which you will be seeking special accommodations abroad, please contact the SBCC Disability Services Program for Students (DSPS) specialist immediately to begin discussions about reasonable accommodations. Phone: (805) ext or (805) or dspshelp@sbcc.edu. The office is located at the Student Services Building SS-160. The process to reach agreement on reasonable accommodations must take place before you leave the US. Students who disclose needs at the last minute or who require accommodations that cannot be made available in the host country may be advised to postpone participation or consider another program. Do you have a medical condition that may prevent you from being able to function in the following situations or to participate in the following activities? Walking on uneven surfaces for at least two miles Climbing several flights of stairs Sitting in buses/ trains/ airplanes for extended periods of time Ability to adjust to substantially different diets Ability to function at times in extremely hot or adverse weather conditions If you checked any of the activities above, please note your medical condition. The information will be shared with our DSPS Office. If you have questions regarding your health as it relates to your ability to participate in the Study Abroad program, please consult with your physician. I have carefully read the brochure for the SBCC Semester in Indonesia Program and wish to apply. I agree to the terms and conditions stated in the program brochure, including the payment and refund policies. I understand that if there are any changes in the terms and conditions, SBCC will notify me in writing. I shall be the client of ASBCC for all purposes. Any applicable refunds will be returned to me regardless of the source of payment. Signature: Date: Required Legal Documents Legal documents will be sent to you after you ve been accepted into the program. If I do not complete and return the required Study Abroad legal documents by the stated due date, I may be cancelled from the program and held responsible for any cancellation penalties, which may apply. Signature: Date: Responses to Questions. On a separate sheet of paper, please answer the following questions. You may either type or clearly print your responses. A paragraph per question is acceptable. Please limit all your answers to all four questions to 1 2 pages. 1. What are 5 things that you are looking forward to about studying abroad? 2. What are 5 challenges that currently worry you the most about going overseas? 3. How do you think the values and perspectives of the host country will be different from your own cultural values? 4. How do you think you will be perceived by the people in the host country, based on your nationality and cultural heritage? 5. This program will involve time on and in the ocean, including snorkeling in shallow ocean waters, boat trips, and wading in coastal areas. Describe your comfort level and experience with these types of activities (Note that it is OK if you have never done them before. We will provide safety instructions and training).

5 SANTA BARBARA CITY COLLEGE STUDY ABROAD PROGRAM Recommendation for Study Abroad Program #1 Please fill out the following recommendation form for who is applying to Study Abroad in Santa Name of Student Barbara City College s Spring 2019 Indonesia Study Abroad Program. Your honest appraisal of this student is appreciated. *** A = excellent B = good C= average D = poor X = no opportunity to observe Academic ability to do college level course work Emotional stability to live abroad Flexibility/ openness to new and different experiences Tolerance and openness to cultural differences Sense of personal responsibility Consideration of others/ work well with groups Other personal characteristics (friendliness, enthusiasm, humor, etc.) Overall evaluation A B C D X Comments (optional) Name: Relationship to applicant: Phone: Date: Thank you! Please return this form to: Santa Barbara City College Study Abroad Office International Education Center 721 Cliff Drive Santa Barbara, CA 93109

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7 SANTA BARBARA CITY COLLEGE STUDY ABROAD PROGRAM Recommendation for Study Abroad Program #2 Please fill out the following recommendation form for who is applying to Study Abroad in Santa Name of Student Barbara City College s Spring 2019 Indonesia Study Abroad Program. Your honest appraisal of this student is appreciated. *** A = excellent B = good C= average D = poor X = no opportunity to observe Academic ability to do college level course work Emotional stability to live abroad Flexibility/ openness to new and different experiences Tolerance and openness to cultural differences Sense of personal responsibility Consideration of others/ work well with groups Other personal characteristics (friendliness, enthusiasm, humor, etc.) Overall evaluation A B C D X Comments (optional) Name: Relationship to applicant: Phone: Date: Thank you! Please return this form to: Santa Barbara City College Study Abroad Office International Education Center 721 Cliff Drive Santa Barbara, CA 93109

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9 Santa Barbara City College Student Conduct Release Form To the SBCC Study Abroad Applicant: 1. Please complete the top part of this form. 2. If you currently attend SBCC, submit this form to the Dean of Student Affairs, in the Student Services Building, Room # SS-260 (second floor). If you currently attend another college or university, give this form and a pre-stamped envelope addressed to Santa Barbara City College, Study Abroad, 721 Cliff Drive, Santa Barbara, CA 93109, to the appropriate Official who handles student discipline at your current institution. 3. Ask the Official to complete and sign the bottom part, then seal and return it directly to Santa Barbara City College Study Abroad Programs in the envelope that you provide. Name: K# Last First Middle (if you are a SBCC student) Current Address: Street Apt. or Box No. City State Zip Phone # Program: Spring 2019 Indonesia Which academic institution do you currently attend? Dates of attendance at your current institution: From to I hereby consent to the Dean of the college I am currently attending to furnish Santa Barbara City College with the information on the form below and I hereby waive my right of access to any statements by said Dean evaluating my activities and me. Signature: Date: To the School Official: The student named above has applied to participate in a study abroad program at Santa Barbara City College. Thank you for taking the time to complete this form and returning it as soon as possible to Santa Barbara City College, Study Abroad Programs, 721 Cliff Drive, Santa Barbara, CA Has this student been subject to any disciplinary actions? Yes No If yes, please explain. Are any disciplinary charges pending? Yes No If yes, please explain. Has this student been expelled, suspended, placed on probation, required to withdraw, or given a reprimand or warning? Yes No If yes, please explain. Is this student eligible to re-enroll at your college? Yes No Conditionally If No or conditionally, please explain. Any additional comments you may wish to make regarding this student. Signature Name (Please print) Title Institution Phone Date