Home School Authorization/Nomination
Student
Authorization
TO THE STUDENT:
Please sign this
authorization form and
give it to your home
school study away
advisor. The
undersigned campus
official must be
authorized to approve
college credit transfer.
THIS SECTION MUST BE COMPLETED AND SIGNED BY THE APPLICANT
Please fill out information completely and type or print in ink.
___________________________________________________________________________________
Name of Applicant
___________________________________________________________________________________
Home School
___________________________________________________________________________________
Term(s) You Plan to Study Away Year
___________________________________________________________________________________
Signature Date
I hereby apply to study at Bennington College for a term or academic year as indicated above and
authorize Bennington College to issue my college or university a transcript after my last term of study
with Bennington College. I also authorize the release of information needed to complete this form for
admission to Bennington College to the academic dean, on-campus coordinator, contact, or study away
advisor. I unconditionally and voluntarily consent to the release of such records pursuant to this
request.
Under the provision of the Family Educational Rights and Privacy Act of 1974, I waive my right of access
to this recommendation and understand that the information provided will be used only for the
purposes for which it was prepared.
Yes No ____________________________________________________________________
Signature Date
Home School
Authorization
TO THE ADVISOR: If
necessary, please use
additional pages to
give us your
evaluation of the
applicant’s abilities
and suitability for a
term or year at
Bennington College.
*The existence of a
disciplinary record or
current disciplinary
sanctions does not
preclude admission,
but will be considere
d
in the overall
evaluation of the
application. If
pr
obat
ion extends past
the Benningt
on
College term start
date, the student will
not be
admitted.
THIS SECTION MUST BE COMPLETED AND SIGNED BY THE APPLICANT’S STUDY AWAY ADVISOR AND
SENT TO xiomaragiordano@bennington.edu.
The application of the above-named student is being submitted with my approval. The credit earned
during the student’s term or year at Bennington will will not count toward the student’s degree.
___________________________________________________________________________________
Name Title/Position
___________________________________________________________________________________
Signature Date
___________________________________________________________________________________
College or University
___________________________________________________________________________________
Telephone Fax
___________________________________________________________________________________
Email
Field Work Term (FWT): Every winter our students are required to complete a 7-week non-credit
bearing internship. Students visiting for an academic year are eligible to complete an FWT.
FWT participation is OPTIONAL for this student.
The student is REQUIRED to complete an FWT.
N/A Student is visiting for one term only.
Disciplinary Information*
This student is currently not on academic or disciplinary probation.
This student is currently on academic or disciplinary probation.
The official college record stating the details is enclosed.
This student’s disciplinary record has been reviewed and approved for study away by an
appropriate official at my institution.
I do not have access to this student’s disciplinary record.
This student is not approved for study away.
Updated 09/2020 - XJG
