Fillable FINAL Proposal PDF Study Abroad Form

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FINAL Proposal PDF Study Abroad Form

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The FINAL Proposal PDF Study Abroad Form form is 18 pages long and contains:

  • 8 signatures
  • 41 check-boxes
  • 122 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Southeastern Louisiana University

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1
FACULTY-LED STUDY ABROAD/STUDY AWAY PROPOSAL FORM
1. FACULTY COORDINATOR INFORMATION
Name of Faculty Program Coordinator: __________________________ W#:_______________
College & Department: ___________________________________________________________
Office Phone #: ________________________ Email: __________________________________
Office Location: _______________________ Box #: ___________________________________
2. PROGRAM INFORMATION
Name of Program: _______________________________________________________________
Program beginning date*: _________________ Program ending date*:___________________
*(Do not include orientation, only class time before and/or after the trip, if any.)
Trip beginning date*: ____________________ Trip ending date: _______________________
*(This date should be the date that students fly out of the U.S. on, not the date they arrive
in the host country.)
○ Term 1 ○ Term 2 ○ Regular Summer ○ May Interim ○ August Interim
○ Spring Break ○ Other
Maximum number of Students: _______ Minimum number of Students: _______
Has the Program been offered before, and if so, when and what was its enrollment?
2
3. PROGRAM OBJECTIVES
Describe the academic and cultural objectives of the program. What provisions for significant
and structured cultural immersion, including contact with citizens of the host country, does the
program feature? What excursions and/or cultural events are planned as part of the program?
How does the cultural program support the academic objectives? (If you need more space than
the box provided, please attach a separate document and check the box below.)
○ Attached (more information)
3
4. ACCOMPANYING TEACHERS (IF APPLICABLE)
Accompanying Faculty #1:
Name: ___________________________ W#:_____________ Office Phone #:______________
Email: _______________________ Office Location: ___________________ Box #:___________
Accompanying Faculty # 2:
Name: ___________________________ W#:_____________ Office Phone #:______________
Email: _______________________ Office Location: ___________________ Box #:___________
Accompanying Faculty # 3:
Name: ___________________________ W#:_____________ Office Phone #:______________
Email: _______________________ Office Location: ___________________ Box #:___________
5. FACULTY DETAILS
Describe the qualifications of the program coordinator and teaching faculty with regards to the
host site(s) and language(s). Include any previous experience teaching in group study abroad
program.
4
6. COURSE(S) TO BE TAUGHT AS PART OF THE PROGRAM
Course(s) Information Table:
Course
Prefix &
Number
Course
Title
Number
of Credit
Hours
Rental
Textbook
Required
(Y/N)
Lab Fees
(Y/N)
Open
for
Audit
(Y/N)
Pre-
requisite
Required
For this
Course
Teacher
7. If any of the courses is a 400/500 level, what are the requirements for graduate
component?
8. If Program will be open for non-credit participants (audit), how will it be tailored for audit?
(If you need more space than the box provided, please attach a separate document and
check the box below.)
○ Attached (more information)
5
9. Discuss the course outline and address how the course will integrate the overseas/away
location(s). State the targeted academic and cultural learning outcomes of the course. Attach a
course syllabus for each Study Abroad course to be offered. The syllabus should be specific for
the program and address the required readings, educational activities, means of student
assessment, and grading methods. Include a table documenting 2,250 minutes of academic
content for each course. Time spent in pre-departure orientation cannot be counted as part
of the 2,250 minutes. (If you need more space than the box provided, please attach a separate
document and check the box below.)
○ Syllabus Attached
○ Attached (more information)
6
10. Include a description of how you will use local resources to deliver the course content
(museums, businesses, etc.). Discuss intended assignments including any work students will be
expected to complete before and after the trip.
11. Attach a tentative daily itinerary of activities covering all program and trip dates. The
itinerary should include a listing and a description of orientation sessions, pre-trip meetings, trip
dates, and post trip date activities.
○ Attached
7
12. LODGING
Type of Housing (check all applicable):
Hotel _______ Dormitory __________ Home-stay __________ Other _________
Describe the housing arrangements for students and faculty, location, amenities provided, and
number of students per room. Provide the contact information for each establishment.
8
13. MEALS
State if meals are included in the program and whether or not faculty meals will be included as
well. Also, state whether the menus are set or if the participants have an option. If some or all
meals are not provided, state how much additional money should participants’ budget to cover
meals.
14. EMERGENCY SERVICES
Detail what emergency services that will be available to students and faculty on the program.
Detail the CDC vaccination requirements and recommendations for all countries of travel in the
program itinerary (cdc.gov). Include medical care available in the region, proximity to
emergency medical services, whether or not 24 hour security is available on the premises,
proximity to police or security officers, etc.
9
15. TRAVEL ARRANGEMENTS AND GROUND TRANSPORTATION
(If the program will require rental vehicles, fill out Vehicle Rental Form
at http://www.selu.edu/admin/controller/facultystaff/travel/forms/vehicle_rental.pdf, and
attach a copy of the completed and signed form.)
○ Copy attached (if applicable).
○ Detailed rate information or contract attached for each.
16. Description, provider, and cost of any other services (ex: Eurail, Bus, etc.):
17. STUDENT SELECTION AND RECRUITING
Discuss criteria to select students for this program, to be consistent with general institution
standards. How much time do you feel you will be able to devote to recruiting students each
week? What types of recruiting activities are you considering in order to let students know
about your program?
10
ESTIMATED PROGRAM BUDGET
To assist in determining program costs, please provide the following estimated student expenses.
Per student expenses: (list all prices in USD)
○ This is a package price that includes meals, transportation, lodging, etc. This price is listed under
lodging (check if applicable)
Airfare (Only if included in program price)
Lodging
Meals
Field trips/excursions
Local transportation
Course materials (books, learning resources, etc.)
TOTAL
Per teacher expenses: (list all prices in USD)
○ This is a package price that includes meals, transportation, lodging, etc. This price is listed under
lodging (check if applicable)
Airfare
Lodging
Meals
Field trips/excursions
Local transportation
Course materials (books, learning resources, etc.)
Miscellaneous items (Phone, Laundry, exit taxes, tips, promotional items & other)
Salary requested (Program Coordinator)
(Choose a Retirement Plan: ○ TRSL ○ ORP ○ LASERS)
Salary requested (accompanying Faculty#1)
(Choose a Retirement Plan: ○ TRSL ○ ORP ○ LASERS)
Salary requested (accompanying Faculty#2)
(Choose a Retirement Plan: ○ TRSL ○ ORP ○ LASERS)
Salary requested (accompanying Faculty#3)
(Choose a Retirement Plan: ○ TRSL ○ ORP ○ LASERS)
TOTAL
11
SIGNATURE APPROVAL FORM
Your signature below indicates that you have reviewed the proposal described above and certify that the
program meets the Departmental and University Standards for quality and content of coursework. You also
certify that the terms of the program, as described above, are in accordance with State, Board, and
University Policies.
Faculty Coordinator and Accompanying Faculty:
Initial each statement below to indicate your acceptance of these requirements.
1. In the event that I am unable to complete a course that is in progress, I agree to assist the school/college
in finding and selecting a replacement faculty coordinator.
⎕ Faculty Coordinator ⎕Accompanying Faculty#1 ⎕ Accompanying Faculty#2
2. I attest that if I make any change to the program I will inform the International Initiatives Office of that
change and also inform all applicants, especially if the change modifies the itinerary, dates or costs.
⎕ Faculty Coordinator ⎕Accompanying Faculty#1 ⎕Accompanying Faculty#2
3. I attest that any program changes (e.g. logistics, fees, dates) will be made before the program application
deadline.
⎕ Faculty Coordinator ⎕Accompanying Faculty#1 ⎕Accompanying Faculty#2
4. I understand, if the program is approved, that attending the in-person Faculty-led Programs Workshop is
mandatory in order for me to lead a course abroad.
⎕Faculty Coordinator ⎕Accompanying Faculty#1 ⎕Accompanying Faculty#2
5. I understand that Southeastern requires me to reconcile my travel expenses within ten (10) days after my
return. If I fail to reconcile my expenses within a month of my return I will not be permitted to take a
travel advance for a future program.
⎕Faculty Coordinator ⎕Accompanying Faculty#1 ⎕Accompanying Faculty#2
Faculty Coordinator Signature: ___________________________________ Date: ______________________
Accompanying Faculty #1 Signature: ______________________________ Date: ______________________
Accompanying Faculty #2 Signature: ______________________________ Date: ______________________
Department Head # 1: By signing below, I attest that this course abroad proposal meets the stated academic
and cultural outcomes, as well as the academic standards of the department. I further approve and endorse the
Faculty Coordinator being assigned to lead this program as described herein.
Department Head Signature: ___________________ Print Name: _______________________ Date: _________
Department Head # 2: By signing below, I attest that this course abroad proposal meets the stated academic
and cultural outcomes, as well as the academic standards of the department. I further approve and endorse the
Faculty Coordinator being assigned to lead this program as described herein.
Department Head Signature: ___________________ Print Name: _______________________ Date: _________
12
Dean: By signing below, I attest that this study abroad proposal meets its stated academic and cultural outcomes,
and I approve its listing. I concur with the Department Head’s assessment of the academic merit of the program.
Dean Signature: __________________________ Print Name: ___________________________ Date: _________
Dean: By signing below, I attest that this study abroad proposal meets its stated academic and cultural outcomes,
and I approve its listing. I concur with the Department Head’s assessment of the academic merit of the program.
Dean Signature: __________________________ Print Name: ___________________________ Date: _________
Director International Initiatives Signature: _______________________ Print Name: _____________________
Date: ____________
Please make a copy for your records. When you have signed the document, please hand deliver entire proposal folder to the
International Initiatives Office or call 2135 for pick up.
Phone#: 985-549-2135 International Initiatives
Fax#: 985-549-3478 Southeastern Louisiana University
Email: studyabroad@selu.edu
Meade Hall 103, 900 N. Pine Street
Web: www.selu.edu/studyabroad Hammond, LA 70402
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FINAL Proposal PDF Study Abroad Form

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Completed 16 March 2020

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