Fillable ICISP Study Abroad Application (Morton College)

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ICISP Study Abroad Application (Morton College)

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Page 1 of 20
ICISP Study Abroad Application
Applicant Name: _______________________________________
Home College: _______________________________________
ICISP Representative: _______________________________________
The following items constitute a complete application:
Completed application packet including pages 1 – 7 (pages 9 - 12 of the packet are for reference for
the student)
1. Checklist (pages 1 - 2)
2. Application page including course selections (Passport numbers may be submitted
after the student receives his/her passport). (Pages 3 - 5)
3. Terms of the Program: (pages 6 - 7)
o Release Agreement
o Medical Agreement/Permission for Emergency Treatment
o Participant Information including cancellation and refund policy
o Student Conduct Agreement including expectations and dismissal policy
4. Housing form (page 17)
Two recommendation forms (pages 13, 15). At least one recommendation form needs to be completed
by a faculty member. The student may choose another college staff or faculty member as his/her
second reference. Recommendations are to be returned to the ICISP representative.
Canterbury applicants must complete and include the Canterbury Application and Accommodation
Forms (page 18).
Carlow applicants must complete and include the Carlow Student Residence Application Form (pages 19-
20)
An official college transcript to verify the following: 1) minimum GPA of 2.75 on a 4.0 scale; 2)
completion of at least 12 hours of college level course work; and 3) completion of one college writing
course (commonly known as English Composition I and/or II; IAI C900 and C1901R or C1900R or C1900),
or equivalent, with grade of B or higher. Another transcript may be required at the conclusion of the
current semester if eligibility requirements for the program are in progress. ICISP representatives are
required to review transcripts to verify student eligibility. Do not send transcripts directly to ICISP. If the
transcript is not included in the student’s application package, the transcript must first be sent to the
student’s ICISP representative for review and then forwarded to the ICISP office.
A typed essay explaining the reasons for participating in the study abroad program, including
expectations and how the program relates to personal and/or career goals. (1000 word minimum).
A copy of the student’s passport. If the student will apply for a passport upon acceptance, a copy of a
government-issued identification (e.g. driver’s license, state id) is acceptable.
Page 2 of 20
A $500 deposit/application fee paid to the student’s home institution must be submitted with the
application. The fee will be applied to the program cost after acceptance. Please attach a photocopy of
the student’s payment to the application.
Carlow, Seville, and Salzburg applicants must submit a digital photograph to the ICISP Program
Assistant, Karen Huber, by email at karen.huber@heartland.edu.
Optional: Submit ICISP Founders’ scholarship application which requires additional photocopy of
student’s transcripts. (Deadlines: Fall Programs – May 15th, Spring Programs – October 15th, Summer
Programs – February 15th)
The completed application packet must be submitted to the home institution’s ICISP representative, allowing
sufficient time for the representative to forward the packet that must be received in the ICISP office by the
application deadline: Fall Programs – May 15th, Spring Programs – October 15th and Summer Programs -
February 15th. Applications submitted to the ICISP office using outdated forms will be returned to the
student’s representative. Late applications will not be considered.
ICISP Representative:
I verify that all items listed above are included in this application. Furthermore, I have reviewed the study
abroad application, verified eligibility, and support the student’s application to study abroad.
_____________________________________________ ________________________
ICISP Representative’s Signature Date
$ ______ payment received by home institution on ___________ (date) Attach photocopy of all payments.
Comments: _______________________________________________________________________________
Page 3 of 20
ICISP Study Abroad Application
I am applying for:
Study in Canterbury, United Kingdom Fall semester 20
Study in Carlow, Ireland Spring semester 20
Study in Salzburg, Austria Summer session 20
Study in Seville, Spain
STUDENT APPLICANT INFORMATION – PLEASE PRINT
Name ________________________________________________ Male: Female:
Address ___________________________________________________________________________________
Street City State Zip Code
E-mail address _________________________________________ Telephone (______) ____________________
Age ______ Date of Birth ______/______/______ Note: Students must be aged 18 or older by program start date.
(dd/mm/yyyy)
College presently attending __________________________________ Home institution student ID: _________
Major____________________________________ Cumulative GPA _________ (2.75 or higher required)
College writing sequence (IAI C1900 and C1901R or C1900R or C1900) Grade _________ (B or higher required)
Number of credit hours completed ________________ Are you applying for Financial Aid? Yes: No:
If applying for financial aid, what type? __________________________________________________________
Passport #: __________________________________ Citizenship: US Other __________________ (specify)
(To be filled in before or at orientation) If other, country of residency ______________________
EMERGENCY CONTACTS
NAME RELATIONSHIP TELEPHONE ADDRESS
1. ________________________ ________________ (_____) __________ ______________________________
(_____) __________ ______________________________
2. ________________________ ________________ (_____) __________ ______________________________
(_____) __________ ______________________________
Page 4 of 20
ICISP Study Abroad Application
PRELIMINARY COURSE SELECTIONS
Four Classes plus Alternate for Semester Programs; Two Classes for Summer Programs
Please detail your preliminary course selections below. The list of articulated and available classes for each
study abroad program can be accessed through your home institution’s ICISP representative. Please note that
course availability is subject to change without notice and may vary by semester. You may only select courses
that have been articulated through ICISP; failure to select courses that have been articulated through ICISP
may result in the class not transferring to your home institution.
Prefix & Course Number Name of ICISP Course ICISP Course Number Home College
Equivalent
1. ______________ ____________________________________ ___________________ __________________
2. ______________ ____________________________________ ___________________ __________________
3. ______________ ____________________________________ ___________________ __________________
4. ______________ ____________________________________ ___________________ __________________
5. ______________ ____________________________________ ___________________ __________________
Alternate course
______________ ____________________________________ ___________________ __________________
Page 5 of 20
_________________________________ __________________________________
Study Abroad Program Semester/Year
_______________________________________________________________________________________
Last Name First Name Middle Name
Female Male _________________________ ___________________________________
Date of Birth (dd/mm/yyyy) Place of Birth (City and State)
_________________________ _____________________________________________________________
Passport Number College presently attending
___________________________________________ __________________________________________
Degree/Certificate pursuing Declared or Intended Major
Write brief comments on the topics below:
Career plans:
Work experience:
Travel experience:
Special interests and/or hobbies:
Language(s) studied and/or spoken:
How did you find out about the program?
ICISP Study Abroad Application
General Information
Page 6 of 20
ICISP Study Abroad Application
Terms of the Program (page 1 of 2)
Release Agreement
I, the undersigned, having applied to the ICISP Study Abroad program in _______________________________
for the _______________ semester, 20_____, do covenant and agree as follows:
I release ICISP and the host institution from any liability or damage or loss of property, injury, illness, or death
during the period of the program.
I understand and agree that neither the Illinois Consortium for International Studies and Programs (ICISP), its
agents, officers, or employees, nor any educational institution associated in this endeavor shall assume any
liability for damages or loss of property or for any financial or other obligations incurred by participants either
in the United States or elsewhere.
I further understand and agree that while participating in the Program, I shall be subject to the supervision and
authority of ICISP, its agents, officers and employees, including the sole decision-making responsibility with
respect to any participants whose conduct or academic standing may warrant expulsion or withdrawal from
the Program. I understand that participants are expected to attend classes regularly unless otherwise indicated
by illness or unavoidable circumstances and to conduct themselves in a mature and responsible way as
representatives of their colleges and their country.
I further understand and agree that when I travel independently from travel arrangements and fieldtrips
organized by the host college and/or by ICISP for participants in the Program I do so at my own risk. I assume
responsibility for my own health, safety, and responsibility for all of my luggage and valuables as a result of this
decision. I hold the host college and ICISP harmless for this decision and was advised as to my personal
responsibility for this decision.
I hereby acknowledge and agree that if I should be required to withdraw from the program for failure to
maintain appropriate standards of study or behavior, that my rights to a refund of any program fees may be
limited and that I would no longer have access to any of the facilities of the Program.
I agree that, should there be any dispute concerning my participation in the Program that would require the
adjudication of a court of law, such adjudication will occur in the McLean County Illinois Circuit Court and be
determined by the laws of the State of Illinois.
I represent that I am at least eighteen years of age or, if not, that I have secured below the signature of my
parent or guardian as well as my own. I further represent that my agreement to the provisions herein is wholly
voluntary, and further understand that, prior to signing this agreement, I have the right to consult with any
advisers, counselors, or attorneys of my choice.
I agree that, should any provision or aspect of this agreement be found to be unenforceable, that all remaining
provisions of the agreement will remain in full force and effect.
Page 7 of 20
ICISP Study Abroad Application
Terms of the Program (page 2 of 2)
Medical Agreement and Release/Permission for Emergency Treatment
On rare occasions, an emergency will develop which requires medical care, hospitalization, or surgery for a
participant. So that such treatment can be administered without delay, we ask that each applicant sign the
following statement authorizing ICISP representatives abroad to secure any necessary treatment.
In the event of injury or illness, I hereby authorize any representative abroad of ICISP to secure any necessary
treatment, including the administration of an anesthetic and surgery.
Agreement to terms of ICISP Study Abroad Programs
I acknowledge that I have read and understood:
The Release Agreement (pg. 6)
The Medical Agreement and Release/Permission for Emergency Treatment (pg. 7)
the Participant Information including Cancellation and Refund Policy (pages 9-10)
the Student Conduct Agreement including expectations and dismissal policy (pages 11-12)
As an applicant to the program, I agree to such terms.
________________________________________ _________________________________________
Signature of Student Applicant Date
________________________________________
Printed Name
_______________________________________ ___________________________________________
Program (Destination) Semester/year
WITNESS SIGNATURE
___________________________________________ ____________________________________________
Signature of Parent or Legal Guardian Date
if Participant is under 18 years of age
___________________________________
Printed Name
Page 8 of 20
Pages 9 through 12 are designed to be kept by the student for reference.
Page 9 of 20
ICISP Study Abroad Application
Participant Information
Program Price
Your campus ICISP representative has provided you with an itemized list of activities and services covered by
the program price. It also stipulates anticipated expenses that are not covered by your program fees. The costs
are estimated based on the rates of exchange between U.S. dollars and foreign currencies at the time the price
was established. As a result, the program cost is subject to change. Every effort is made to establish a realistic
price for the program. However, in the unlikely event that it becomes necessary to increase the program cost
after it has been advertised, participants may withdraw from the program within seven days of the date of the
revised invoice with no penalty whatsoever. Withdrawal for reasons other than price increase falls under the
normal cancellation policy described in a separate section.
Use of Photos and Testimonials
Students participating in ICISP study abroad programs permit ICISP to use their names and photographs taken
during the education abroad experience and statements made in written program evaluations in study abroad
publications, reports, press releases, promotional literature, websites, and posters. ICISP reserves the right to
copyright all photos and promotional literature used by the consortium.
Passports
Students who do not have a passport at the time of application are strongly encouraged to apply for a passport
immediately. Failure to secure a passport may mean that the student will not be able to participate in the
program.
Air Transportation
Participants will make their own flight arrangements to their destination. Each ICISP program will provide
information on meeting the group at a pre-arranged time and place (usually an airport or the point of entry for
the group). Failure to meet the group on time and any extra costs incurred as a result is solely the
responsibility of the participant.
Deposits and Payments
A $500 deposit is due with the completed application form and subject to the cancellation and refund policy
on page 9. Applications received after the final deadline will not be considered. Please submit all payments
payable to applicant’s home institution to the ICISP representative. Final payments must be made to the home
institution prior to the orientation date. Payments must be made on schedule or the student risks being
dropped from the program.
Orientation
The student will be informed by the ICISP office of acceptance to the program and the date, time and location
for the orientation session. Orientation sessions for Canterbury, Carlow, Salzburg and Seville are generally held
from 9:30 a.m. to 1:00 p.m. at Heartland Community College in Normal, Illinois approximately 6-8 weeks prior
Page 10 of 20
to departure. Orientation is mandatory. Final processing, meeting other participants and obtaining detailed
program information during orientation will maximize the student’s experience.
Financial Aid
Students apply for financial aid on their home campus. Students who will receive financial aid, but not in time
to make scheduled payments, must arrange for a short-term loan. Deposits must be made on time to overseas
institutions and vendors so the Consortium cannot wait for payments beyond the established deadlines.
Cancellation and Refunds
If, for any reason, the Consortium cancels a scheduled study abroad program prior to departure, ICISP's only
liability will be to refund the monies paid into the program by the student.
Please understand that, if you change your plans for any reason, your right to a refund is limited. The
following cancellation schedule applies to all ICISP consortial programs.
------------------------------------------------------------------------------------------------------------------------------
Written Notice received by ICISP Cancellation Penalty
------------------------------------------------------------------------------------------------------------------------------
Up until two weeks before orientation No penalty
From two weeks before orientation A cancellation penalty of the application
until two working days after orientation fee/deposit will be imposed.
Three or more working days The cancellation penalty will be determined by
after orientation ICISP based upon advance deposits and
payments made on behalf of the student.
Day of departure or later NO REFUND
ALL CANCELLATIONS MUST BE MADE IN WRITING AND SENT TO:
Heartland Community College/ICISP
ICISP Program Assistant
1500 West Raab Road
Normal, IL 61761-9446
CAMPUS: 309-268-8664
FAX: 309-268-7986
EMAIL: karen.huber@heartland.edu
No refunds will be made for any services provided in the itinerary that you do not use.
If you have any questions regarding the above information, please contact your ICISP representative or the
ICISP Program Assistant at the above address.
Page 11 of 20
ICISP Study Abroad Application
Student Code of Conduct and
Agreement
Participation in the Illinois Consortium International Studies and Programs (ICISP) study abroad program is
conditional upon the understanding and following of specific behaviors, rules of the host country and your
home institution, and accountability for one’s actions while participating in the program. Therefore, ICISP
representatives, as well as those in charge of ICISP programs on site, have full authority to enforce agreed-
upon standards. Further, they have full authority to take necessary steps to provide for the safety and full
participation of all students, while participating in on-campus activities, off-campus field trips, and other travel
as decided upon by the student. This may include, but not be limited to: advising the student’s ICISP
representative, advising the student’s family, giving a warning of possible future dismissal from the program,
and finally, sending the student home at the student’s expense, with no reimbursement of payments. The
student agrees to the following:
PERSONAL CONDUCT
As a guest in another country students are responsible and must conform to all laws of that country and rules,
customs, and standards of the host institution. Be aware that you are also under any code of conduct
determined by your home institution. Students must conduct themselves in an appropriate manner at all
times. Inappropriate behavior is cause for dismissal from the program.
PROGRAM PARTICIPATION and CLASS ATTENDANCE
Students are expected to attend classes, maintain a full time course load as defined by the program, and
attend all field trips. Attendance is mandatory unless specific arrangements have been made with the on-site
program directors. Unauthorized absences are grounds for disciplinary action and possible dismissal from the
program.
INDEPENDENT TRAVEL
While it is assumed that students may wish to participate in additional travel unrelated to the program,
students must understand that commitment to their educational program at the overseas institution is
primary and takes precedence over all other recreational travel. Students must understand and acknowledge
that they accept full responsibility for personal travel. Students must inform their host family, as well as the
ICISP or other representatives of the program, of overnight absences, and provide their itinerary so that in case
of emergency they may be contacted.
LEGAL PROBLEMS
The student is responsible for all legal problems with any foreign nationals or government jurisdictions of the
host country. ICISP cannot be held responsible for the well-being, health or safety of the student when he/she
is absent from the program. The student accepts liability and is financially responsible for any damage or injury
he/she may cause. The host institution, ICISP, or the student’s Host College does not guarantee what, if any,
assistance can be provided.
Page 12 of 20
DISMISSAL POLICY
The In-Country Program Directors reserve the right to dismiss any student at any time for any of the following
infractions:
violation of any rules mentioned above,
disruptive behavior,
excessive absences from the academic program including field trips,
use of illegal drugs,
excessive use of alcohol,
any conduct that appears in the In-Country Program Director’s judgment to be disruptive to the
student or incompatible with the interest or welfare of others or the reputation of the program.
Students dismissed from the program will remain responsible for all program costs incurred on their behalf,
and will be sent home at their own expense. Full loss of academic credit may also result.
DISMISSAL PROCEDURE
1. The In-Country Program Directors, the host institution, or the host family identifies violation of any
program rules.
2. In-Country Program Directors discuss the violation with the student and a course of action is agreed
upon and documented. This is faxed to the ICISP Study Abroad Coordinator who will contact the ICISP
representative.
3. If remediation does not occur within the agreed-upon time frame, and if the student continues to
break the rules of the agreement, he or she will be contacted by the In-Country Program Directors for
immediate dismissal.
All students participating in an ICISP program must sign this agreement. Any student who refuses to sign will
not be allowed to participate in an ICISP program.
Page 13 of 20
ICISP Study Abroad Application
College Faculty or Staff Recommendation
(Form 1)
___________________________________________ has applied for admission to the Study Abroad Program
in _________________________________________ for the _________________ semester, 20______.
Please indicate below your evaluation of this student:
Excellent Good Poor Unable to Judge
Probable academic success 5 3 1 0
Dependability 5 3 1 0
Maturity 5 3 1 0
Ability to get along with others 5 3 1 0
Adaptability to a new environment 5 3 1 0
Independence 5 3 1 0
Trustworthiness 5 3 1 0
Open-mindedness 5 3 1 0
Social contact 5 3 1 0
Sense of humor 5 3 1 0
Good ambassador from 5 3 1 0
your college/United States
Please comment in a separate letter on the student's ability to do academic work abroad and to adjust to
living in a foreign environment.
_________________________________ _________________________________
Printed Name of Reference Signature of Reference
________________________________ ________________
Title - Division/Department Date
Please return this form to __________________________________ on or before ______________________
ICISP Representative (date)
Page 14 of 20
This page is intentionally left blank so recommendation form may be distributed as needed.
Page 15 of 20
ICISP Study Abroad Application
College Faculty or Staff Recommendation
(Form 2)
___________________________________________ has applied for admission to the Study Abroad Program
in _________________________________________ for the _________________ semester, 20_____.
Please indicate below your evaluation of this student:
Excellent Good Poor Unable to Judge
Probable academic success 5 3 1 0
Dependability 5 3 1 0
Maturity 5 3 1 0
Ability to get along with others 5 3 1 0
Adaptability to a new environment 5 3 1 0
Independence 5 3 1 0
Trustworthiness 5 3 1 0
Open-mindedness 5 3 1 0
Social contact 5 3 1 0
Sense of humor 5 3 1 0
Good ambassador from 5 3 1 0
your college/United States
Please comment in a separate letter on the student's ability to do academic work abroad and to adjust to
living in a foreign environment.
_________________________________ _________________________________
Printed Name of Reference Signature of Reference
________________________________ ______________________
Title - Division/Department Date
Please return this form to __________________________________ on or before ______________________
ICISP Representative (date)
Page 16 of 20
This page is intentionally left blank so recommendation form may be distributed as needed.
Page 17 of 20
ICISP Study Abroad Application
Housing Form: Canterbury, Salzburg, Seville
This form is to be completed by applicants to Canterbury, United Kingdom; Salzburg, Austria; and Seville,
Spain. One of the most important experiences of the ICISP Programs is the living situation with families. Living
with a family gives you greater insight into the society and culture as well as a "home away from home".
Although living with a family requires some adjustments, at times even the sacrifice of a small amount of your
independence, almost all students in the past have agreed that living with a family is definitely preferable to
dormitory living. However, you can be assured that the families perfectly understand that you are adults, who
wish to travel on weekends, that there are no curfews, etc. Ultimately, it will depend upon you, whether you
wish a very personal close relationship with your family or whether you prefer a more independent situation.
Most homestays in Canterbury and Seville are located no further than a 40 minute walk to campus. For
homestays in Salzburg, students may need to take a bus to campus.
In order to give the college administration input on the housing arrangements preferred please fill in the
information below.
Name: _______________________________________________________
I would prefer a family: with children without children no preference
I would prefer: close contact more independence
If possible, I prefer a single room: yes no
I smoke: yes no
I am a vegetarian: yes no
This is my first time living away from home: yes no
On a scale of 1-9, with 9 very comfortable and 1 not at all comfortable.
How comfortable are you with dogs? _________
How comfortable are you with cats? _________
How comfortable do you feel about living abroad? _________
List any allergies you have: ______________________________________________________________
I would like to have____________________________ as a housemate (please note that this request may not
be honored by the host institution).
Other comments:
_________________________________________________________________________________
Page 18 of 20
Additional Application Form for Students Applying to Canterbury, United Kingdom
Status (Please Specify):
Mr. Mrs. Ms. Miss
Male Female
Given Names:
Family Name:
Date Of Birth (dd/mm/yyyy)
Citizenship: U.S.______ Other:______
If other, please specify:_____________________
Country Of Current Residence:
Passport Number:
Telephone Number:
Mobile Number:
Fax Number:
Email Address:
Accommodation Application Information for Canterbury
Special requirements/allergies:
Preferences for accommodation placement:
Other things your home stay family should know about you:
Message for the home stay family:
Page 19 of 20
Application Form for Students Applying to Carlow, Ireland
Carlow College Student Residence Application Form
Last Name: __________________________________________
First Name: __________________________________________
Nationality: __________________________________________
Date of Birth: __________________________________________
Gender: Male Female
Address : __________________________________________
__________________________________________
Telephone Number: ___________________ Mobile / Cell Number: ____________________
Email Address: __________________________________________
Emergency Contact Name: ____________________________________
Telephone Number: ___________________ Mobile / Cell Number: ____________________
Date of Arrival: ___________________________
Date of Departure: ___________________________
Page 20 of 20
If there are other details relevant to your application, such as a medical condition or special needs, which
you would like us to be aware of, please give details.
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
I, the above named student, accept terms and conditions of this contract and agree to abide by the rules of
Lennon House.
Signed: ___________________________ Date: ________________
= = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =
Office Use Only
Approval of Application Yes No
Room Number: ___________________________
Signed: ___________________________ Date: ________________
On behalf of Carlow College Management Board
Signed: ___________________________ Date: ________________
On behalf of Lennon House Management
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