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Faculty-Led Application Packet-Fillable

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BROWSE MONTANA STATE UNIVERSITY - BILLINGS FORMS

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10.19-AC
FACULTY-LED STUDY ABROAD APPLICATION CHECKLIST
Office of International Studies – McDonald Hall #150 – 1500 University Drive - Billings, MT 59101
Your complete application must include the following:
Phase 1: Application Materials –
1. MSUB Application Form for Study Abroad.
Please type this form or print in ink and submit to the
Study Abroad Program Manager at the Office of International Studies (OIS).
2. Personal Essay. Submit to the Office of International Studies (OIS) a one-page typed essay
explaining what you hope to achieve in your study abroad program, both academically and personally.
3. Unofficial Transcript. Submit unofficial transcript to OIS. You must have completed 24 university
credits by the start of the program and have a minimum cumulative GPA of 2.5. Some programs are
flexible.
4. Study Abroad Agreement to Participate. Initial each page where indicated; sign and date. Students
who are legal / financial dependents should review the agreement with their parents or guardians. If you
do not understand the agreement, or have any questions, the Study Abroad Program Manager will go over
it with you.
5. Health/Emergency Treatment Authorization. Include emergency contacts. Complete, sign, and date.
6. International Health Insurance Form. Complete all spaces, sign and date. All study abroad
students must agree to enroll in the MSU international health insurance for the duration of the study
abroad experience. Insurance is typically figured into the overall faculty-led program price.
7. Physical Exam. All students must receive a basic physical exam stating that they are fit to travel.
MSUB students may have the exam done for free at Student Health Services. Submit a signed doctor’s
form to OIS. Check the CDC website http://www.cdc.gov/travel for information on required or
recommended vaccines for the country (or countries) you plan to visit.
8. Budget Form (if using financial aid for study abroad). Use the budget form to assess the cost of
studying abroad. If you want to use financial aid for your program, you must have the budget form signed
by the Director of Associate Director of Financial Aid. Please make an appointment to meet with the
Director or Associate Director of Financial Aid to discuss what financial aid may be applied to your study
abroad program. Note: not all programs are eligible for additional financial aid allocation.
9. $150 Application Fee & Designated Deposit (if applicable – refer to program advertisement for
deposit information). Please pay any fees at the Business Office (McMullen Hall Basement). The fee(s)
must be posted to your student account as “Study Abroad Application Fee” and the program name for the
deposit (if applicable). Submit the receipt to OIS. Fees are refundable on a case-by-case basis or if the
program is canceled.
Phase 1 Application Materials due:
May/Summer Faculty-Led Program
Applications are Due:
December 1
st
, with Deposit (unless
otherwise advertised
10.19-AC
10. Study Abroad Candidate Official Interview. In order to be officially admitted to the study abroad
program, students must complete a 30-minute interview with OIS staff and a faculty group leader. After
you have completed your application, the OIS will contact you to set up your official interview.
Phase 2: After Acceptance
11. Passport. Apply for a passport immediately if you do not have one. U.S. citizens, go to
http://travel.state.gov/passport/ for information. If you already have a passport, please check the
expiration date. Be sure it will be valid for at least 6 months beyond your intended return to the US. Bring
your signed passport to OIS as soon as possible so we can make a copy of the front page, including your
picture, passport number, and passport expiration date.
12. Foreign Country Visa Application. Visas are country and program specific. Work with Study Abroad
Program Manager to apply for a visa if necessary.
13. Pre-Departure Orientation. All students MUST attend a Pre-Departure Study Abroad Orientation. If
you fail to attend the orientation, you may be dismissed from participation in the program.
Phase 3: Pre-Departure Travel & Payment – Due ASAP
14. Travel Information. Purchase your plane ticket and forward a copy of your travel information to the
Study Abroad Program Manager: studyabroad@msubillings.edu. OIS must have your full travel itinerary
before you depart. Not relevant for pre-purchased group travel.
15. Go to the U.S. State Department Website- http://travel.state.gov and register for the Smart Traveler
Enrollment Program (STEP): https://step.state.gov/step/ for free information and updates related to safety
in your intended destination(s).
16. MSU Travel Registration (REQUIRED). No less than 30 days before departing, all students
participating in a university designated program must register their travel plans in the University’s
International Travel Registry. Information entered into the Travel Registry will be available to University
officials in the event of a crisis or emergency. Students cannot register their travel until their course
registration has been completed. Once the course registration is listed on your MyInfo account, you may
register your travel at:
https://montana.studioabroad.com/index.cfm?FuseAction=Security.LoginWizardStepOne. You will need
digital copies of your passport and insurance card to complete this registration and will also need to
provide an estimated travel itinerary.
17. Payment of Tuition through MSUB and MSUB HOLDs. You must log in to pay the tuition for your
program as well as any HOLDs (library, parking, past due amounts, etc.) directly to MSUB, before the
regular deadline for the semester. You can check for HOLDs on your “My Info Login.”
10.19-AC
APPLICATION FOR FACULTY-LED STUDY ABROAD PROGRAM
Office of International Studies – McDonald Hall #150 – 1500 University Drive - Billings, MT 59101
Name MSUB ID#
Date of Birth / / (Must be at least 18) Email
Month/Day/Year
Sex F M Citizenship _______________ Passport Number__________________________________________
Check here if your passport application is in process
MSUB in-state student MSUB out-of-state student NON-MSUB student: Current University
Name of study abroad program:
Country/counties of program:
Dates and year of program:
MSUB exchange or study abroad program NON-MSUB study abroad program: specify:_________________________________
NOTE TO STUDENT: If the following information is different than what the University has on its system, you must update your changes at the Registrar's Office.
Current mailing address*: Apt #: Phone:
Street address
Work phone:
City State Zip
*Address expires: / /___ . Permanent address: Apt #:
Month/Day/Year
Street address
Phone:
City State Zip
Major: Expected graduation (Month/Year):
College: Allied Health Arts & Science Business City College Education Number of program credits:
Status during program: FR SO JR SR GR Other (24 cr. required before group study abroad)
Foreign language(s) studied: __________________ Years studied: __________ (Two years of study prior to time abroad is recommended)
Current cumulative grade point average (GPA):
(Min. 2.5 GPA – some group programs may be flexible. Submit unofficial transcripts)
Will you be using financial aid? yes no Have you filed a FAFSA for the study abroad period? yes no
(Including loans, MET, scholarships & grants) (If not, complete as soon as possible. Available at Financial Aid, McM 103.)
Are you considered as a dependent on the tax form of your parent/guardian? yes no
I give the Office of International Studies permission to share/discuss my study abroad plans with my parents/guardians. yes no
How did you learn about this study abroad program? (Check all that apply)
Faculty Member Office of Int’l Studies Class Friends Study Abroad Event Former Participant
Poster/Flyers MSUB website Other (specify):
By submitting this signed application, I understand that:
I will forfeit my $150 application fee and deposit if I withdraw from the program after I have been accepted to the program.
The Office of International Studies will not accept verbal cancellations by phone or e-mail notification; withdrawal must be in writing.
I will be withdrawn from the program and will forfeit my application fee if I do not attend the pre-departure orientation meeting or fail
to complete any portion of the application and enrollment process.
I give the Office of International Studies permission to order and release my student records and transcript to persons directly involved
with the acceptance and processing of my application.
All information on this application form is complete and accurate to the best of my ability.
Signature: Date:
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10.19-AC
FACULTY-LED STUDY ABROAD AGREEMENT TO PARTICIPATE
Office of International Studies – McDonald Hall #150 – 1500 University Drive - Billings, MT 59101
In consideration of participation in Montana State University Billings study abroad program,
I,___________________________________, hereby agree to the following conditions:
1. I understand and will abide by the rules governing student responsibility and behavior as stated in the Montana
State University Billings’ Student Affairs Policies and Procedures, including the Code of Student Conduct,
as published in the Student Handbook. I recognize that violations of the law and/or MSUB regulations or
policies may result in (i) immediate dismissal from the program; (ii) academic withdrawal from the University
for the semester in progress; and (iii) disciplinary action upon my return to campus.
2. I will become informed about and will comply with the laws, rules and regulations, and customs of my host
country, community, institution and program as administered by the faculty or resident director(s), or other
representative(s) of Montana State University Billings. To be acceptable, behavior should show a genuine
concern for the mores and social patterns of the host culture, in order that actions not be offensive to the
community.
3. The program director and the director of the MSUB Office of International Studies shall have the right to
dismiss me from the program at any time if (i) my conduct violates Montana State University Billings’ Code
of Student Conduct; (ii) I violate laws, rules and regulations, or customs of my host country, community,
institution and program; or (iii) the program director and the MSUB Office of International Studies have
reasonable cause to believe that my continued presence in the program constitutes a danger to the health or
safety of persons or property or threatens the future viability of the program. The following behaviors are
among those that may result in immediate dismissal from the program: alcohol abuse; physical or sexual
assault; harassment; possession, use or distribution of illegal drugs; setting a fire or possession of explosives;
possession of a weapon; theft. The program director, with the concurrence of MSUB’s Office of International
Studies, may temporarily suspend me pending final resolution of the matter.
4. In the event of an infraction which does not cause an immediate danger and where there is an allegation of a
violation of the laws, regulations, and customs of the host country, community, institution or program or a
violation of the MSUB Code of Student Conduct, the director of Office of International Studies has the right
to enforce the standards of conduct described in the Student Handbook, in its sole judgment, and that the
director will impose sanctions, up to and including expulsion from the Program. I recognize that due to the
circumstances of foreign study programs, procedures for notice, hearing and appeal applicable to student
disciplinary proceedings at MSUB do not apply. I understand that a decision made to dismiss me from the
program will be final and I consent to being sent home at my own expense with no refund of fees.
5. The University may make changes to the program itinerary at any time and for any reason, with or without
notice, and the University shall not be liable for any loss whatsoever to participants by reason of any such
cancellation or change. The University is not responsible for penalties assessed by air carriers based on
operational and/or itinerary changes regardless of whether the participant or the University makes the flight
arrangement. The University may substitute hotel accommodations or housing at any time. Specific room
and housing assignments are within the sole discretion of the University.
Study Abroad Participant Initials___________
10.19-AC
6. The University assumes no responsibility or liability, in whole or in part, for any delays, delayed or changed
departure or arrival times, fare changes, dishonors of hotel or transportation reservations, missed carrier
connections, sickness, injuries (including death), losses, damages, weather, strikes, acts of God, public health
risks, criminal activity, terrorism, expense, accident or damage to property, inconveniences, failure or
negligence of any nature in connection with any accommodations, restaurant, transportation, or other service
or for any substitution of hotels or common carrier beyond the University’s control, with or without notice,
or for any additional expenses occasioned by any of the foregoing. If due to weather, flight schedules or other
factors I am required to spend additional nights, the University will not be responsible for my hotel, transfers,
meal costs or other expenses. My baggage and personal property is transported at my risk entirely.
7. The University, in its sole discretion, may cancel the program or any aspect of the program prior to departure
and, in its discretion, the University may cancel the program or any aspect of the program after departure,
requiring that all participants return to the United States, if the University believes that any person is or likely
will be in danger if the program or any aspect of the program is continued. I understand that if I ignore or
refuse to comply with the University’s directive to return to the United States I do so at my own risk.
8. I understand that I am required to provide my full travel itinerary to/from my host country, along with the
travel itinerary for any program related trips, to the Office of International Studies prior to departure for each
trip.
9. I understand that I must demonstrate minimum levels of health and medical emergency insurance. As such,
the State of Montana has ensured affordable access to international health insurance for students through a
statewide contract with GeoBlue International Health Insurance for Higher Education. Enrollment in GeoBlue
International Health Insurance is mandatory for all students traveling internationally on a University affiliated
and/or sponsored program.
10. The University will not provide any administrative support (housing, childcare, etc) or assume any
responsibility for accompanying non-participants. Accompanying non-participants are limited to
spouses/partners and children. I understand that I am responsible for obtaining overseas health insurance for
myself and any accompanying non-participants. I understand that such accompanying non-participants are
not part of the program and therefore cannot attend classes, field trips, or any other activities formally
associated with the program. I understand if such individuals become disruptive to the program, it may be
grounds for my dismissal.
11. I shall be responsible for my own health care, conduct, financial integrity and travel plans while studying
abroad on a University-sponsored study abroad program. In the event of serious illness, accident or
emergency, my designated emergency contact, as indicated on the Student Health/Emergency Treatment
Authorization, may be notified. I shall inform the faculty member-in-residence, on-site director(s), or program
assistant(s) representing the Office of International Studies of problems that arise during my stay abroad so
that assistance can be provided.
Study Abroad Participant Initials___________
10.19-AC
12. I shall be solely responsible for any and all additional costs incurred on my behalf by the university while
participating in the program. In addition, I shall be solely responsible for any and all costs arising out of my
voluntary or involuntary withdrawal or dismissal from the program prior to its completion, including but not
limited to withdrawal or dismissal for reasons of health, family emergency, illegal drug use or alcohol abuse,
legal detention, or disciplinary action by a representative(s) of the University. Costs incurred on my behalf
include, but are not limited to, monies advanced on my behalf for non-refundable deposits at other institutions,
airfare, accommodations, legal documents, and visa and application fees.
13. If I withdraw, depart or am dismissed from a program for any reason prior to its formal completion, I may not
be eligible for any academic credits. Should I receive permission to return home early, I may be eligible to
receive a grade of “W” on my University academic transcript. University tuition and fees may be refunded
according to University policy, as stated in the Schedule of Courses publication for on-campus enrollment.
14. I, individually, and on behalf of my heirs, successors, assigns, and personal representatives, hereby release
and forever discharge the University and its employees, agents, officers, trustees and representatives (in their
official and individual capacities) from any and all liability whatsoever for any and all injuries, illnesses,
damages, losses (including death) I sustain to my person or property or both, including but not limited to any
claims, actions, damages, expenses, and costs, including attorney fees, which arise out of, result from, occur
during or are connected in any manner with my participation in the program and/or any related travel.
15. I, individually, and on behalf of my heirs, successors assigns, and personal representatives, hereby agree to
indemnify, defend and hold harmless the University and its employees, agents, officers, trustees and
representatives (in their official and individual capacities) from any and all liability, loss, damage or expense,
including attorney fees, that they or any of them incur or sustain as a result of any claims, actions, damages,
expenses, or costs, including attorney fees, which arise out of, occur during, or are in any way connected with
my participation in the program or any related travel.
16. This agreement is to be construed under the laws of the State of Montana, USA; and if any portion of this
Agreement is held invalid, the balance of this Agreement shall, notwithstanding, continue in full legal force
and effect.
In signing this document I acknowledge that I have read this entire document, have had an opportunity to
ask questions, understand its terms, agree to the terms stated, am giving up substantial legal rights I might
otherwise have, and have signed it knowingly and voluntarily.
Signature: Date:
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10.19-AC
FACULTY-LED STUDY ABROAD HEALTH/EMERGENCY TREATMENT AUTHORIZATION
Office of International Studies – McDonald Hall #150 – 1500 University Drive - Billings, MT 59101
The purpose of this form is to help the Office of International Studies (OIS) provide appropriate assistance to you should the need arise during your
study abroad experience. It is important that we be aware of any medical or emotional problems, past or current, which might affect your ability to
participate in the MSUB study abroad program. The information provided will remain confidential and will be shared with program staff, faculty, or
appropriate professionals only if pertinent to your well-being.
All Study Abroad applicants must have a physical exam and submit the Doctor’s evaluation to OIS. The physical exam may be done at Student
Health Services: 406-657-2153 (no charge for students currently enrolled at MSUB).
Name: MSUB ID#:
Last First
Sex: F M Date of birth: / / Citizenship:
Month/Day/Year
Current address: Apt #: Local phone:
Street address
Work phone:
City State Zip
Country/countries of study abroad program:
Date and year of program:
Emergency Contact: Please list who should be notified in case of an emergency
1. Name: Relationship to you:
Last First
Address: Apt #: Home phone:
Street address
Work phone:
City State Zip
Cell phone: E-mail:
2. Name: Relationship to you:
Last First
Address: Apt #: Home phone:
Street address
Work phone:
City State Zip
Cell phone: E-mail:
Health Information: Please list the following or indicate “N/A” if not applicable
Food allergies:
Dietary restrictions or requirements:
Allergies (plants, insectes, etc.):
Immunizations received in the past 90 days:
- OVER -
10.19-AC
Medical History: This is required to coordinate treatment in the event of a medical emergency. Answer “N/A” if not applicable.
Medical allergies:
Medication taken on a daily or routine basis and purpose for use:
Note: Participants should bring an adequate supply of medications that are required on a daily or routine basis, in addition to a new, original prescription from your
doctor in case you need to have your medication replaced/filled while abroad.
List any circumstances or health conditions (such as surgery; hospitalization; injuries; chronic condition; physical, psychological, emotional, or
mental illness) that may need special consideration before or during your experience or may affect your ability to participate in this program:
The following must be completed. If you do not have a regular physician, indicate where your medical records are kept.
Physician name:
Office phone: ( ) Emergency phone: ( )
Address:
Health and Emergency Agreement
I authorize the release of information contained in this Student Health/Emergency Treatment Authorization form for access and review
by the director of Office of International Studies and the appropriate health professionals in the MSU-B Student Health Services. I give
these individuals permission to communicate my health condition with each other and with any physician, psychologist, or counselor
who treated me during the past four years. I understand that if this information is pertinent to my well-being abroad, it may be
communicated to overseas medical professionals providing treatment, the MSUB International Oversight Committee, the MSUB
program leader, and the host institution’s resident director.
In the event that I need emergency medical care, hospitalization, or surgery while participating in the program, I authorize Montana
State University Billings, through its representatives, to secure any necessary treatment. If coverage is not provided through medical
insurance, I understand that such treatment shall be solely at my expense, and I shall reimburse Montana State University Billings or its
representatives for any expenses that they might incur on account of my condition or treatment. In the event of any emergency abroad,
Montana State University Billings may notify my designated emergency contact.
I certify that all responses made on this form are complete, true and accurate, and I will notify the Office of International
Studies immediately of changes in the state of my health. I understand that approval and participation in this study abroad
program is contingent on receipt by the MSUB Office of International Studies of this completed and signed form.
Participant Signature: Date:
If you have any questions regarding medical problems, immunization requirements, or other health
issues, call Student Health Services, 657-2153, at least 45 days prior to departure.
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10.19-AC
FACULTY-LED STUDY ABROAD INTERNATIONAL HEALTH INSURANCE FORM
Office of International Studies – McDonald Hall #150 – 1500 University Drive - Billings, MT 59101
Students traveling abroad on a designated University program must demonstrate minimum levels of health and
medical emergency insurance. As such, the State of Montana has ensured affordable access to international health
insurance for students through a statewide contract with GeoBlue International Health Insurance for Higher
Education. Enrollment in GeoBlue International Health Insurance is mandatory for all students traveling
internationally on a University affiliated and/or sponsored program. More information concerning international
travel insurance and GeoBlue enrollment may be found on the Office of International Programs’ MSU
International Travel Compliance webpage.
All group faculty-led programs already have insurance costs figured into the program fee and the coverage
dates will be the actual program dates.
Full Name (to be listed on your insurance card): MSUB ID#:
Sex: Female Male Date of Birth: / /
MM DD YYYY
Permanent Address (where your insurance card will be mailed):
Address City State Zip
Please read and complete this section indicating that you understand the insurance requirements for
Study Abroad at MSU Billings.
By signing, I acknowledge that I understand I must agree to acquire international health insurance through the
Montana University System designated insurance provider. I understand that my insurance will be setup by the
Office of International Studies at MSU Billings. I understand that the cost of the insurance will be added to my
student account and that I am required to pay this amount prior to the start of my study abroad experience. Once
my insurance has been processed, I am responsible for keeping my issued insurance card on hand and contacting
the insurance company with any questions or issues I may have while abroad. I am able to use this coverage in
foreign countries and know how to contact the insurance company from abroad in order to get assistance. I
acknowledge that I have filed emergency contact information with MSU Billings. I understand that failure to file
this information may result in the revocation of my privilege to participate in the program.
Signed _______________________________________ Date______________________
10.19-AC
FACULTY-LED STUDY ABROAD BUDGET FORM
Office of International Studies – McDonald Hall 1
st
Floor – 1500 University Drive - Billings, MT 59101
This form is for you to list all necessary direct educational expenses for your study abroad experience as well as
expected funding for your trip. If you anticipate using federal financial aid to pay for part of your trip, please
make an appointment with either the Director or Associate Director of Financial Aid, as you will need him/her to
sign off on this form. Most faculty-led programs include many of these expenses in the overall program price,
so please refer to the program advertisement for reference or contact the OIS for price inclusion confirmation.
Please note that not all faculty-led programs are eligible to receive additional financial aid support – please
consult with the Study Abroad Program Manager to confirm your program’s eligibility.
Estimated Expenses
Expense
Amount
Faculty-Led Program Fee
$
Airline Ticket (if NOT included in program fee)
$
Passport, Visa, other documents
$
Miscellaneous Living Expense (local transportation, food, etc.)
$
Total
$
Estimated Revenue
Funding Source
Amount
Federal Financial Aid (FAFSA)
$
Personal Funds
$
Miscellaneous Support
$
Total
$
*** If you want to utilize Financial Aid toward your study abroad program, then the back page must be filled out in its entirety and
a meeting with the Director of the Financial Aid Office must be arranged prior to submission of completed application to the
Office of International Studies ***
- OVER -
10.19-AC
Frequently Asked Questions about Financial Aid
& Study Abroad Programs
Can FINAID be used toward my faculty-led program?
o Sometimes. Financial aid can only be applied for a faculty-led program if the program fits within the
parameters of the designated awarded semester. If the program takes place in May, then it must start
directly after the conclusion of the spring semester and end within 14 days of the end of the semester.
Programs that take during the designated semester meet the financial aid eligibility requirements.
What do I do differently if I am paying tuition to Bozeman instead of Billings when I go abroad?
o Fill out your FAFSA as usual and fill out the Consortium Agreement form that can be found at the OIS or
Financial Aid offices. This agreement applies your Federal Aid to Bozeman as a Billings student, and
adjusts for the higher cost of education at Bozeman.
Should I meet with the FINAID Director/Associate Director before turning in my application to the OIS?
o YES! He/She will help you walk through monetary options available (e.g. loans & grants) for your time
abroad. Circumstances arise that may require backup funding to pay for surprise costs. One must be
realistic about potential risks and financial solutions.
What if I want to take summer classes at MSUB after I return back home? Can I have FINAID for my
summer session(s) at MSUB?
o YES! The Financial Aid Office will need a class list to award you FINAID for the summer session(s).
You will be awarded funds based on how many classes you take and the amount of funding available
during the summer. The sooner your class list is submitted to the Financial Office, the better your
chances of increased funding.
Can I just stop by the Financial Aid Office and chat with the Director or Associate Director?
o NO! All students must make an appointment. Realize that you might have to wait a week or two to get in
with him/her (especially during their “busy” months of processing FAFSA applications). BUT,
sometimes the Director is available for a quick chat, so stop by & make the necessary arrangements.
What happens if I have more FINAID questions?
o Contact a member of the Financial Aid Office.
o McMullen Hall, 1st Floor East Wing
406-657-2188| FAX (406) 657-1789
finaid@msubillings.edu
Name:__________________________________________ MSUB ID #: _________________________
Email:__________________________________________ Phone:______________________________
Permanent Address:____________________________________________________________________
Address City State Zip
Study Abroad Program:_________________________________________________________________
University Country
Study Abroad Program Dates:____________________________________________________________
Start Date (Month/Year) End Date (Month/Year)
If receiving Financial Aid, to be signed by the Director or Associate Director:
Financial Aid Office: ____________________________________________________________________
Director’s or Associate Director’s Signature: _______________________________ Date: ____________
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Faculty-Led Application Packet-Fillable

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Completed 21 February 2020

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