FACULTY-‐LED STUDY ABROAD PROGRAM APPLICATION SUMMER 2018
Dear Student, Thank you for your interest in applying to participate in an ACC faculty-‐led study abroad program. There are several steps required to complete the application process, starting with a mandatory advising session. You should schedule your advising appointment prior to filling out this application so that you can learn more about the study abroad program you are interested in. Advising sessions can be scheduled through the ACC website. Program Application Submission Period: August 28, 2017 to March 9, 2018 Mandatory Advising Sessions: Monday, Tuesday, Thursday, and Friday: 10:00am-‐2:00pm Advising Session Appointment: http://www.austincc.edu/degrees-‐and-‐certificates/find-‐classes/study-‐abroad/study-‐abroad-‐advising-‐session
You can submit the completed application in person, mail, or email. Completed applications can be submitted after an advising session starting on August 28, 2017. Completed applications will be processed on a rolling basis until the application deadline of March 9, 2018. Austin Community College International Programs Highland Business Center, Room 508.4 5930 Middle Fiskville Road Austin, TX 78752 E:
[email protected] T: +1-‐512-‐223-‐7114
FACULTY–LED STUDY ABROAD PROGRAM APPLICATION CHECKLIST ITEM
DESCRIPTION / INSTRUCTIONS
Program Application
5 pages
Color copy of your passport data page
1 photocopy of your passport data page (photo and signature page).
2 Passport-‐Size Photos
2 inches x 2 inches.
If you do not have a passport, please submit proof that you have applied for one (i.e., receipt). Passport-‐size photos are available at International Programs.
Proof of Health Insurance
Please provide a copy of your insurance card. If you do not have insurance, please indicate that you will purchase an ISIC
Unofficial ACC Transcript
Please provide a copy of your most current transcript. IMPORTANT DATES
August 28, 2017 to March 9, 2018
Program Application Submission Period
Rolling basis until March 30, 2018
Program Application Acceptance Notification
Rolling basis until March 30, 2018
Participant Confirmation and Deposit Deadline
April 2, 2018
Program Fee Payment Deadline
SUBMISSION SUBMIT PROGRAM APPLICATION IN PERSON, MAIL, OR EMAIL TO Austin Community College International Programs Highland Business Center, Room 508.4 5930 Middle Fiskville Road Austin, TX 78752 E:
[email protected] T: +1-‐512-‐223-‐7114 Revised 07/10/2017
FACULTY–LED STUDY ABROAD PROGRAM APPLICATION Program Information Study Abroad Program
Affix Passport-Size Photo
Faculty Leader(s)
Applicant Information First Name Middle Name Last Name
Date of Birth
Age
Female
q Male q
E-‐mail Address
Mailing Address City State Zip Code
Cell Phone
Home Phone
Work Phone
Ethnicity: Asian
q Black q Hispanic q White q Hawaiian/Pacific Islander q Native American q Alaskan Native q Other q
Education Information Are you an ACC student? Yes
q No q
ACC ID
Current ACC classification
Field of Study
Associate Degree
q
Certificate
Professional Development
Total ACC credit hours completed
Current GPA
1st year
q
Transfer
Main Campus
q q
Are you on academic or disciplinary probation? Yes
q No q If yes, please explain.
Does your study abroad program have course prerequisites? Yes
q No q If yes, please list.
Have you taken the course prerequisites? Yes
q No q What g rade(s) did you receive?
Passport Information Do you have a passport? Yes
q No q
What is the Passport Number?
Issuing Country?
Passport Issue Date?
If no, have you applied for a passport? Yes When/where did you apply?
Revised 07/10/2017
q No q
Passport Expiration Date?
q 2nd year q
FACULTY–LED STUDY ABROAD PROGRAM APPLICATION Health Insurance Information Do you have health insurance? Yes
q No q
Insurance Provider
Primary Insurance Holder
Out-‐of-‐area coverage? Yes
q No q
General Medical Information – Attach a sheet of paper if more space is required. Do you have any allergies? Yes
q No q If yes, please list.
Will you be taking prescription medication while overseas? Yes
q No q If yes, please list.
Do you have a history of mental health treatment? Yes
q No q
If yes, please explain.
Are there any activities in your selected program that you cannot physically do? Yes
q No q If yes, please explain.
Do you require any special accommodations to participate in study abroad? Yes
q No q If yes, please explain.
Emergency Contact Information – Please only list persons who will help you in an emergency. Primary Contact Name
Relationship to Applicant
E-‐mail Address
Address
Cell Phone
Home Phone
Work Phone
Work Phone
Secondary Contact Name
Relationship to Applicant
E-‐mail Address
Address
Cell Phone
Home Phone
International Travel Experience Have you traveled abroad before? Yes
q No q
Where and when did you travel?
Have you participated in a study abroad program? Yes
q No q
If yes, what was the program?
Revised 07/10/2017
FACULTY–LED STUDY ABROAD PROGRAM APPLICATION How did you learn about the program? Please check any that apply. Poster/Flyer/Brochure
International Programs Website
General Information Session
Campus Information Table
International Programs Class Visit
Study Abroad Faculty Leader Class Visit
ACC Faculty Member
Advisor/Counselor
ACC Social Media
ACC Study Abroad Participant
Other (please explain)
Revised 07/10/2017
FACULTY–LED STUDY ABROAD PROGRAM APPLICATION RELEASE OF STUDENT INFORMATION
During the course of your application to and participation in an ACC faculty-‐led study abroad program, International Programs may need 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, and emergency or non-‐emergency information related to your health or safety. Please choose one: q I authorize International Programs to provide relevant information from my educational records as described above. q I do not authorize International Programs to provide relevant information from my educational records as described above. Student Signature Date APPLICATION AGREEMENT Please check each statement after you have read and understood each item. q I have been advised about my study abroad program by International Programs. I understand that program dates, itinerary, and fees are subject to change. I understand that all study abroad program fees are non-‐refundable unless the program is cancelled by International Programs. q I understand I must meet with the study abroad faculty leader for an interview. I understand that if I do not complete the faculty interview, my program application will be suspended. q I understand I will be notified of my acceptance by an official email and letter from International Programs. I also understand my acceptance letter will include the required forms that I must return per the deadlines in the acceptance letter. I further understand that I must remit a $400 non-‐refundable deposit to secure my place in the study abroad program. q I understand International Programs may contact my emergency contacts listed on this application in the case of an emergency that affects me during the study abroad program. q I understand that the Student Handbook for Study Abroad Programs contains important information related to my participation in a study abroad program and that it is my responsibility to read the handbook and to follow the rules and procedures. I understand I can obtain a copy at any time from International Programs. Student Signature Date Revised 07/10/2017
FACULTY–LED STUDY ABROAD PROGRAM APPLICATION QUESTIONS Please type or print legibly. No more than two pages total. I. II. III. IV. V.
Why do you want to study abroad?
How does the program you selected relate to your personal and academic goals?
What personal, professional, or academic qualities make you a good candidate for this program?
How will you meet the financial requirements of the program you selected?
Do you have any health or physical issues that might impact your study abroad participation?
Revised 07/10/2017
