STUDY ABROAD APPLICATION

We are pleased you are interested in applying to study abroad through Ivy Tech Community College. This application is for students who currently attend Ivy Tech Community College. If you are not a current student, please contact the Program Coordinator (room 325 - E) to obtain the appropriate application materials. Attached to this application are the Ivy Tech Community College Study Abroad Policies and Procedures. Please review the policies and procedures before applying. Name: Ivy Tech student ID #: STUDY ABROAD APPLICATION Phone: Cell phone: Name of study abroad course: Country/countries of program: Semester/term and year of program: Number of credits you plan to take abroad: Do you plan to use financial aid? Yes No (including loans, scholarships, and grants; does NOT include OSA Scholarships) If yes, have you filed a FAFSA for the study abroad period with the Office of Financial Aid? Yes No (If not, complete one as soon as possible.) EMERGENCY CONTACTS Please list two different contacts that should be notified in case of an emergency. Name: First Contact Information Relationship to you: Home Phone: Work Phone: Cell Phone: E-mail (if applicable): Name: Second Contact Information Relationship to you: Home Phone: Work Phone: Cell Phone: E-mail (if applicable): HEALTH & SAFETY a) I hereby represent and warrant that I am and will be covered throughout the Program by a policy of comprehensive health and accident insurance, which provides comprehensive health and accident insurance policy for injuries and illnesses I sustain or experience overseas, and, more specifically, in the country that I will be living and/or traveling while on the Program, as well as emergency evacuation and repatriation of remains insurance. I agree to show proof of such coverage by submitting a copy of my valid health insurance card. I agree to purchase an International Student Identity Card (ISIC), which will be in effect the entire length of the Program. I b) I hereby represent and warrant that my health insurance policy will adequately cover me while outside the United States. I agree to report to the Program Coordinator s Office any physical or mental condition I have, which may require special medical attention or accommodation during the Program as early as possible, but no later than thirty (30) days prior to departure from the U.S. c) I acknowledge and recognize that the Ivy Tech is not obligated to attend to any of my medical or medication needs, and I assume all risk and responsibility therefore. If I require medical treatment or hospital care, in a foreign country or in the United States, during my participation in the Program, the College is not responsible for the cost or quality of such treatment or care. Ivy Tech may (but is not obligated to) take any actions it considers to be warranted under the circumstances regarding my health and safety. I agree to pay all expenses related thereto and hereby release Ivy Tech from any liability for any such actions.

REFERENCES Please list the name, telephone number, and email of two references who may be contacted regarding your participation. (Do NOT list friends or family members) Name: Phone: Email: Name: Phone: Email: How did you learn about study abroad at Ivy Tech? (Please check all that apply) Plasma Screen Department/College Newspaper Friend Faculty/Staff Member Web Former Participant Class Other Which of the following most influenced your decision to apply for this particular study abroad program? (select one) Degree Requirements Educational Goals Faculty Member Foreign Language Study Affordability Career enhancement Academic Advisor Academic Challenge Personal Growth Have you traveled abroad for longer than a week? Yes No If yes, where? Canada Mexico Continental Europe Africa Asia Oceania UK/Ireland Middle/Near East Latin America/Caribbean Other Did the study abroad program at Ivy Tech Community College influence your decision to attend Ivy Tech? Yes No ESSAY If you are applying to a fall semester, spring semester, or an academic year program you must also submit an essay with your application. Some summer programs also require an essay. Please check with the program leader or the Program Coordinator (room 137) about your program requirements. Essays must: Include your name and the name of your program and its location Be typed and no longer than one page in length Incorporate the following: o Why you want to study abroad and why you are interested in this particular program o How studying abroad will help you meet your academic, professional, and personal goals o What personal strengths you have that support your acceptance into this program o How you plan to apply your experience upon returning to the United States Essays should be attached to your application form and be submitted by the appropriate deadline. RELEASE OF STUDENT INFORMATION During the course of your participation in a study abroad program, the Program Coordinator may wish to provide relevant information from your educational records to your parents, guardians, or other third parties. Depending on the circumstances, information to be released might include your student account information, information about the program in which you are enrolled, or non-emergency information related to your health or safety. Please choose one: I authorize the Program Coordinator to provide relevant information from my educational records as described above I do not authorize the Program Coordinator to provide relevant information from my educational records as described above. I also authorize the Program Coordinator to release my information to the following individuals: APPLICATION AGREEMENT The statements below refer to the Ivy Tech Community College Study Abroad Policies and Procedures attached to this application form. Check each statement after you have reviewed each item. I have read the Ivy Tech Community College Study Abroad Policies and Procedures. I understand I will be notified of my acceptance by an official letter from the Program Coordinator that will be sent to the applicable address I have registered with the College. I also understand that my acceptance letter will include the required forms that I must return within two weeks from the date of my acceptance letter or I will be withdrawn from the course. I give the Program Coordinator permission to order and release my student records and transcript to the persons directly involved with the acceptance and processing of my application. I have read and understand the withdrawal and transfer policies of the Program Coordinator. I understand that I must submit the withdrawal or transfer of my application in writing to the Program Coordinator in order for it to be officially recognized. I consent to the use of my image in video, photograph, audio tape, written, or computer generated image by Ivy Tech Community College or Ivy Tech Foundation, or both. I understand that this consent is perpetual, that I may not revoke it, and that it is binding on my heirs and assigns. Signature: Date:

STUDY ABROAD POLICIES & PROCEDURES This document is a summary of policies and procedures that Ivy Tech Community College students should review before applying to a study abroad program. Please detach this page before submitting your application. You will need to review the Harlaxton College Student Handbook located at http://www.ueharlax.ac.uk/admissions/useful_info/studenthandbook.cfm APPLICATION AGREEMENT Deadline for application submission for the June, 2009 class is Monday, December 15, 2008. The following deadline dates should be taken into consideration before you apply to a program: January 28, 2009 (earliest date for registration after acceptance) Summer course (June 13, 2009) to Harlaxton Since selection is done on a rolling admissions basis, we strongly recommend that you apply early as many programs will be filled to capacity prior to above deadlines (applying early may also enable you to take advantage of airline discounts). Some programs have earlier application deadlines. Applying early does not guarantee acceptance. In some cases, you may submit an application after the deadline but your acceptance may be influenced by the late submission. ELIGIBILITY AND ACCEPTANCE These are college-level programs. No high school students will be considered for participation unless they have graduated and are enrolled at Ivy Tech Community College as a matriculating student. You must be in good academic standing, with a GPA of at least 2.0 (or the minimum GPA as determined for the program), at the time of application. Meeting this minimum GPA does not, however, guarantee acceptance: additional eligibility criteria may apply and you must be judged academically prepared by appropriate program leaders. Acceptance to all programs is based, minimally, on a program leader review of your transcript and a review of disciplinary records. Your transcript and status will be obtained directly by the Program Coordinator, and need not be submitted with your application. If the institution the student will be attending overseas requires medical insurance, proof of insurance must be provided in order for the student to be eligible for the program. Cost of insurance is borne by the student. Ivy Tech does not provide primary international health insurance. You will be notified of your acceptance status by an official letter from the Program Coordinator. Please note that although you may receive informal communication from your program leader regarding the status of your acceptance, it is not official until you receive this letter. Letters are sent to your current address as indicated in the official Ivy Tech Community College database or to your home address during winter break. Acceptance is contingent on maintaining the minimum GPA required for the program and on continued review of your disciplinary record. At acceptance, you will receive an official acceptance packet that includes a Decision Form, Student Health/Emergency Treatment Authorization, and Education Abroad Program Agreement. By signing and returning these forms you will be notifying the Program Coordinator that you either wish to participate in, withdraw from, or transfer from the program. These forms must be returned within two weeks of the date of your acceptance letter or it will be assumed that you wish to withdraw your application. Your participation may be denied or your participation approval may be revoked if your conduct before departure raises doubts as to your suitability for the program participation. RELEASE OF INFORMATION Student records and transcripts will be released to persons directly involved with the acceptance and processing of a student application. In addition, during the course of a student s participation in study abroad program, the Program Coordinator may wish to provide relevant information from the student s educational records to the student s parents, guardians, or other third parties. Depending on the circumstances, information to be released might include student account information, information about the program in which the student is enrolled, or non-emergency information related to the student s health or safety.

ADDRESSES, PHONE NUMBERS AND EMAIL The Office of Student Affairs will contact you based on the information you have provided to the Office of the Registrar: Local: Permanent: The address and phone number at which you reside while Ivy Tech Community College is in session. OSA will send communication to this address when Ivy Tech Community College is in session during the fall and spring semesters, including spring break The address and phone number at which you reside when Ivy Tech Community College is not in session. This will often be your parent s address. OSA will send communication to this address between fall and spring semesters and during the summer. You can check you Campus Connect account to ensure your information is up-to-date. If you need to change any of this information, please contact the Office of the Registrar. (The Office of Student Affairs cannot make such changes.) Additionally, if you have indicated a cell phone or work phone on your application form, the Program Coordinator may also utilize those numbers to contact you if necessary. All email communication from OSA will be sent to your Ivy Tech Community College Campus Connect email account, as well as all electronic billing notifications. STUDENT GUIDE Students will receive a copy of the Study Abroad Student Handbook with their acceptance packet. The guide contains important information about OSA policies and procedures, financial matters, travel arrangements, safety and health considerations, and adjustment issues. It is meant to be a comprehensive reference. Please read the contents carefully. FINANCIAL AID AND SCHOLARSHIPS You can use your Ivy Tech Community College financial aid to help cover the cost of the participating in a study abroad program. If you indicate on your application that you plan to use financial aid to help pay for your study abroad experience, the Program Coordinator s Office (Room 325 - E) will forward your Financial Aid Approval Form that includes all anticipated costs to the Office of Financial Aid for processing. If you are interested in obtaining a breakdown of the total cost, please contact the Program Coordinator directly. WITHDRAWAL AND TRANSFER POLICY PRIOR TO ACCEPTANCE If you have not yet been accepted into a program, you may withdraw or transfer your application at any time. To withdraw or transfer your application, you must inform the Program Coordinator, not the program leader. The Program Coordinator s Office will not accept verbal cancellations or transfers by phone or email notification; withdrawal or transfer must be in writing. AT ACCEPTANCE If you have been accepted into a program you will be allowed two weeks after the due date of the acceptance letter to withdraw or transfer your application to another program without financial obligation. If, however, you have not returned your Decision Form before or within the two weeks of the date of the acceptance letter, the Program Coordinator s Office (Room 325 - E) will assume you no longer wish to participate and you will be withdrawn from the program. If you withdraw or transfer from a program, it is also your responsibility to withdraw from your study abroad courses. Notification of withdrawal or transfer must be made in writing to the Office of Student Affairs before the withdrawal or transfer will be officially recognized. The date the Decision Form or written notification is received is the date by which the financial calculation will be determined. If the balance is due to the Office of Student Affairs at the time of withdrawal, that amount must be paid to Ivy Tech Community College to cover expenses incurred to that point. If you withdraw from the program prior to the program s first day, you will be required to withdraw from your course(s) and will receive a full refund of tuition and matriculation fees. If you withdraw after the program s first day, refunds for recoverable tuition and fees will be based on the College calendar.

(a) (b) (c) STANDARD OF CONDUCT I understand and acknowledge that Ivy Tech s policies on Alcohol, Drug Use, Sexual Harassment, and the Student Code of Conduct apply whether I am on the home campus or abroad. I also agree to abide by these policies. I understand and acknowledge that each foreign country has its own laws and standards of acceptable conduct, including dress, manners, morals, politics, drug use, and behavior. I recognize that behavior, which violates those laws or standards, could harm the College s relations with those countries and the institutions therein, as well as my own health and safety. I will become informed of, and will abide by, all such laws and standards for each country to or through which I will travel during my participation in the Program, including attending any and all Program orientation meetings and reading all materials the Program provides. I will attend to any legal problems I encounter with any foreign nationals or government of the host country or any country to or through which I travel during my participation in the Program. Ivy Tech is not responsible for providing any assistance under such circumstances. I understand and acknowledge that the Program Director will be the sole judge of whether my actions hurt the Program, myself or others in the Program or seriously offend the host culture. If they do, the Program director or someone s/he appoints, such as the on-site Director, may terminate my participation in the Program. I understand and acknowledge that should my participation in the Program be terminated, I will receive no refund of any fees, I am required to leave the Program immediately, and that I am solely responsible for arranging and paying for my own transportation back to the United States. RISKS OF EDUCATION ABROAD I understand that participation Ivy Tech s Education Abroad Program involves risks, hazards, and dangers not found in the study at the College. I am aware of, understand, acknowledge, appreciate that these risks, dangers, and hazards involve traveling to and within, and returning from, one or more foreign countries, including risks of air travel and all other types of transportation that could result in damage to property, injury to persons, or death; foreign political, legal, social, and economic conditions; different standards of design, safety and maintenance of utilities, including computing facilities, buildings, public places and conveyances; and local sanitation, medical, and weather conditions. I am aware of, understand, acknowledge, and appreciate the risks, hazards, and dangers of travel to, in and around, including but not limited to the dangers to my own health and personal safety, including loss of property, personal injury, or death posed by war, terrorism, crime, civil unrest, kidnapping, illness, public health risks, accidents, and/or violence. Applicable current travel advisories issued by the U.S. Department of State and the Center for Disease Control information materials either have been received or Internet site addresses provided to me. Further, I have made my own investigation and I am willing to accept these risks, hazards, and dangers. Please return to Kelly Cozart, Program Coordinator, Room 325 E or Martha Seal, Marketing Coordinator, Room 137