OFF-CAMPUS PROGRAMS Application for England Semester, Fall 2018 Application Deadline: November 28, 2017 BIOGRAPHICAL INFORMATION Name: Last First Middle Initial Student ID: Date of Birth: Phone: Westmont E-mail: Gender: Mail Box: Cell Phone: Other/Personal E-mail: Permanent Address: Street City State Zip Parent/Guardian Name (Emergency Contact): Address: Street City State Zip Home Phone: E-mail: Work Phone: Cell Phone: Are you a U.S. citizen? If no, country of citizenship: If not a U.S. citizen, are you a permanent U.S. resident? Full name as it appears on your passport: Passport Number: Passport Agency/Authority: Date of Issue: Date of Expiration**: **Passport MUST be valid for 6 months beyond return to the US from Westmont in England. You must have a valid passport meeting these criteria by Feb. 1, 2014. ACADEMIC INFORMATION Current Class Standing: Fr. So. Jr. Sr. Graduation Major: Minor:
RELEVANT COURSEWORK 1. Name all courses in literature, British culture, theater, or writing that you have already taken or are currently taking at Westmont or another college. Identify the instructors and dates of the course. a. b. c. d. e. f. g. h. Course Title Grade When With Whom # of Papers 2. Name any additional relevant courses in literature or writing you are certain to have taken by August 2018. ESSAY QUESTIONS Please answer the following essay questions as completely as you can on a separate sheet of paper. 1. What are your goals and expectations for England Semester? 2. What two or three books would you say have especially influenced you? Briefly describe why. 3. How would you describe your current relationship to God or your spiritual journey? 4. Please describe your experience(s) in community living. What have been the advantages and disappointments of such experiences?
TRAVEL EXPERIENCE 1. Have you been on any other Westmont off-campus program? Specify. 2. Have you ever traveled in England before? Explain. 3. Have you traveled or lived elsewhere in the world for an extended period? Explain. INTERESTS AND ABILITIES Students can contribute to the life of the group in many ways. Please let us know if you have any of the following special interests or abilities: dramatic acting or directing? musical performance or composition? drawing, painting, calligraphy, cartooning, or photography? athletic, outdoor or hiking skills? tutoring? editing? leading worship? computer technology, telecommunications, or web experience? public speaking? cooking or catering? other (please explain) Advisor s approval for participation in program Advisor s Name: Signature: RECORDS OFFICE APPROVAL (Please take this form to the Records Office for completion) Applicant has at least a 2.3 gpa please circle YES NO If the student will complete 59 units by the end of the current semester, student has officially declared major(s) and minor (s). If the student will complete 70 units by the end of the current semester, student has requested an Application for Degree for every major and minor planned. Forms must be submitted to the Records Office prior to departure abroad. Records Staff Signature:
STATEMENT OF UNDERSTANDING, PERMISSION FOR RELEASE OF INFORMATION, AND WITHDRAWAL DEADLINES 1. I certify the information given on this application to be correct and I agree to abide by all the rules, regulations, and requirements of Westmont College and the Off-Campus Programs Department. 2. I understand that my participation in an Off-Campus Program is conditional upon maintaining satisfactory (a) academic standing in Westmont College (minimum 2.3 cumulative GPA) and (b) Student Life standing (no sanctions) at Westmont College. Initial. 3. I also understand that (a) my application will be reviewed and approved by those responsible for selection, (b) I must obtain medical clearance for any current mental or physical health issue, or should a mental or physical health issue arise prior to departure for the program, (c) in certain cases, acceptance by the host institution may also be contingent on the availability of appropriate facilities or services at the host institution to provide for any special health conditions I may have. 4. I hereby permit Off-Campus Programs to make the information contained in this set of application papers available to the parties directly involved in my placement in a host institution and to government agencies, such as consulates, for visa purposes. 5. I hereby authorize the registrar to release my academic records to Off-Campus Programs as required. 6. I hereby authorize those parties involved in my admission to an off-campus program to consult with Disability Services, and with the Student Life Department regarding my record as a member of the community. 7. I understand that if I wish to restrict disclosure of directory information, which is normally released by Off-Campus Programs without student consent, I must notify Off-Campus Programs in writing. 8. I understand that Off-Campus Programs students remain eligible for Westmont financial aid. Financial aid includes, but is not limited to, Title IV Federal Aid programs (with the exception of Federal Work Study) based on the student s financial need. In addition, I understand that Westmont grants and loans may only be used once for approved programs other than the Europe, England, Mexico and SF Urban Westmont programs. 9. I understand that I must be cleared with the Business Office and Chaplain s Office to register for the semester in question in order to participate in this Off-Campus Program as a Westmont student. 10. I have discussed my participation in this program with my academic advisor and have made the plans necessary to complete all parts of the general education and major program without special accommodation by Westmont College. 11. I understand that I may not enroll in two programs in consecutive semesters. 12. I understand that Westmont College will follow the grading policies (e.g. regarding pass/no pass availability, withdrawal deadlines) of the off campus program. 13. I understand that if I end up changing my classes once I arrive at the program, I must contact my advisor and the records office immediately (records@westmont.edu) to receive approval for any changes. 14. I understand that students enrolling in an off-campus program are subject to all the same registration deadlines and eligibility requirements as apply for on-campus registration. 15. I understand that semester long programs are considered academic credit-bearing programs and therefore are ineligible for solicitation of funds to support Westmont College or an individual student. Should someone choose to make contributions toward student program costs, no receipts/ tax credits will be issued. 16. I agree to receive all information/updates via email and will be responsible to read email related to study abroad at Westmont. Name of student: Signature of student: Please return all forms to the Off-Campus Programs Office no later than November 28 th, 2017
England Semester Fall 2018 Personal Recommendation Application deadline: Fall Semester - For the student to be fairly considered, it is vital that all recommendations be in by the deadline. Applicant: Please fill out this portion and give to reference: Applicant s Name: Name of Reference: Title: Circle One: I agree or do not agree to waive my right to access this reference Applicant s Signature: 1. How long and in what capacity have you known the applicant? 2. Please indicate the student s emotional maturity and adaptability. Comment on areas such as: adaptability to new situations, interpersonal skill, emotional maturity, self-confidence/self-esteem, ability to function as part of a group, skill in self-appraisal, initiative, leadership abilities, capacity for relating to those with differing beliefs or values. 3. Describe this student's level of Christian maturity, commitment and understanding: 4. Additional remarks or other issues we should be aware of. Please include any suggestions, which would be helpful for our faculty in working with this student. Your Name: Title: Dept/ Org.: Phone Number: PLEASE RETURN TO: Off-Campus Programs Office, Westmont College, 955 La Paz Rd, Santa Barbara, CA 93108. Fax: 805-565-7142