Fillable SHORT-TERM/FACULTY-LED STUDY ABROAD APPLICATION Instructions: Complete the Application (Hood College)

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SHORT-TERM/FACULTY-LED STUDY ABROAD APPLICATION Instructions: Complete the Application (Hood College)

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SHORT-TERM/FACULTY-LED STUDY ABROAD APPLICATION
Instructions: Complete the Application Form, read and sign the Release Agreement, and return both to the
Director of Study Abroad.
(Note: PLEASE BLOCK PRINT)
I. PERSONAL INFORMATION:
Name as it appears/will appear on Passport:
First ____________________ Middle ____________________ Last ___________________________
Preferred Nickname: ____________________ Student ID#: ____________________
Hood Email Address: ___________ @hood.edu
Gender on Passport: Male Female
Permanent Address: ------------------------------------------------------------------------------------------------------------------
Home Phone: __________________________ Cell Phone: __________________________
Date of Birth (M/D/Y): __________________________ Current Age: __________________________
Country of Birth: ________________________ Country of Citizenship: _____________________________
Emergency Contact: __________________________(Name) Emergency Contact’s Phone
Number______________ Emergency Contact’s Email Address___________________________
Are you on Facebook? Y N Other Social Media___________________________
Would you be interested in writing for the College’s Blog? Y N
II. MEDICAL INFORMATION:
PLEASE NOTE THAT THE RELEASE OF THE FOLLOWING CONFIDENTIAL INFORMATION IS STRICTLY VOLUNTARY; HOWEVER, FAILURE
TO ALERT HOOD COLLEGE OF ANY SERIOUS MEDICAL/PSYCHOLOGICAL CONDITIONS WHICH MAY REQUIRE SPECIAL
ACCOMMODATION ABROAD, OR WHICH MAY RESULT IN SERIOUS INJURY TO YOURSELF OR OTHERS, COULD LEAD TO YOUR
DISMISSAL FROM THE STUDY ABROAD PROGRAM.
Please list any prescribed medications you regularly take:
_________________________________________________________________________
Please list any allergies of which you are aware:
_________________________________________________________________________
Please indicate whether Hood College should be aware of any medical, physical, or psychological conditions
that may affect your participation in this study abroad program:
_________________________________________________________________________
Health Insurance Provider, Agency, and Policy Number:
__________________________________________________________________________
Accommodations: Please indicate whether you require academic or housing accommodations. Please note
that disability accommodations may not be available in all countries and programs, and arranging for
accommodations frequently takes longer when working with an institution or program located outside of
the United States. Therefore you are encouraged to discuss your need for accommodations in your study
abroad program with the Office of Accessibility Services (AccessibilityServices@hood.edu; 301-696-3569) as
soon as possible.
III. STUDY ABROAD INFORMATION
I am planning to study abroad in the short-term study abroad program organized by
___________________________________________ in __________________ (dates of program).
Have you met with and been advised on this study abroad program by the Director of the Study Abroad?
Y N If no, please schedule an appointment.
Do you have a current passport: Y N
If no, you have: Applied Not yet applied (Apply now if you have not done so!)
Passport No.: ___________________ Expiration Date: ________________________
Have you travelled abroad before? Y N If yes, where and for how
long?_________________________________________________________________
ACADEMIC INFORMATION
Who is your academic advisor? ________________________________ Cumulative GPA: ______________
Major(s): Minor: _________________________________________________________________________
What is your class year? Freshman Sophomore Junior Senior
Expected Graduation Date: (month/year) ________________________
Please list any other languages other than English that you speak and/or read. How many semesters/years
have you been learning this language/these languages: __________________________________________
If we need to check academic references, what two professors would you use as references?
1. ___________________________________________ 2. _______________________________________
QUESTIONS/CONCERNS
1. Why do you wish to travel and study abroad?
2. How does study abroad fit into your future academic and career goals?
3. What, if any, special challenges do you expect to encounter while on this program? How will you deal
with them?
4. Please list additional questions or concerns that you might have regarding your travel (i.e. international
voltage requirements, currency, dealing with seasickness, special accommodations, etc. Use reverse if
necessary.)
5. Is there any additional information that would be helpful for the College to be aware of during your study
abroad period? Y N If yes, please explain:
DECLARATION
I certify that I have had the full opportunity to read and consider the contents of this application. I
understand that by signing this form, I am confirming my authorization that the College may use and/or
disclose the protected information described in this form concerning any emergency, medical, academic,
disciplinary, or health-related issue involving or relating to me, or to any conduct, misconduct, alleged
misconduct, student disciplinary proceeding(s), academic proceeding(s), or legal proceeding(s) involving or
relating to me in any manner. The confidentiality of this information will be maintained consistent with the
College’s need to provide program services.
I understand that I will be required to attend mandatory orientation sessions given by the study abroad
office as a condition of being approved for studying abroad through Hood College.
I agree to obtain any and all visa and clearances prior to my time abroad.
I understand by completing this form that I have read and understand the terms, conditions, and
cancellation policies of the study abroad provider (if the program is organized by a provider).
I understand by completing this form that if I decide to not to or cannot participate in this trip, I will notify
the faculty organizers and the Director of Study Abroad. I understand that I will be responsible for any non-
refundable deposits, fees, and expenses that I have made on my own behalf or have been made on my
behalf.
I understand that Hood College reserves the right to deny students participation in this study abroad
program if the student is not academically ready based upon GPA and/or discussion with the faculty
advisor, or if there are valid financial or behavioral reasons that would indicate the inability to manage
travelling successfully abroad.
Furthermore, I certify that all of the responses made on this form are true and accurate, and that I will
notify the study abroad office hereafter of any important changes in my health or conduct status that occur
prior to the start of the program.
Applicant Signature: ______________________________________
Date: ___________________________
For Office Use ONLY: Submission Date: ________________________________
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GENERAL RELEASE AGREEMENT
Hood College is concerned for the safety and comfort of students, faculty, staff, alumni, or any affiliates
who travel with and participate on any study abroad programs. I hereby agree to the following guidelines:
WHEREAS, Hood College participates in a study abroad / exchange program in _________________________________________________ (the
“Host Country”) from ________________________ to ______________________; and WHEREAS, __________________________ (“Participant”),
voluntarily desires to participate in the program; IT IS HEREBY AGREED by and between the Participant, the Participant’s Parent or Legal Guardian if
Participant is under the age of 18, (collectively “the Undersigned”) and Hood College, as follows
1.0 Participation in the Academic Program
The Undersigned have been informed by Hood College of the scope and focus of the Program, eligibility requirements, costs, registration
procedures, travel, itinerary, logistics, terms of cancellation, academic context, and credit. By signing this Agreement and General Release, the
Undersigned acknowledge that they have fully educated themselves as to the details of this Program and agree to abide by its terms. It is expressly
acknowledged that the Participant is not required to participate in the Program. In consideration of the Undersigned’s execution of this Agreement
and General Release and their agreement to be legally bound by the terms, Hood College will permit the Participant to enter into the Program
subject to the provisions set forth herein.
2.0 Waiver of Hood College’s Liability for Risks and Dangers
The Undersigned understand that there are certain dangers, hazards, and risks inherent in international travel and the activities included in the
Program, including but not limited to risks of injury, permanent disability or death, property damage, and severe social or economic loss, which may
result from the actions, inactions, or negligence of the Participant or others, weather conditions, conditions of equipment used, language barriers,
differing social cultures, national and local laws, sickness, weather, strikes, natural disasters, civil unrest or hostilities, terrorist activities or acts of
war, and that Hood College cannot and does not assume responsibility for any such personal injury, property damage, or other loss.
3.0 Participant Responsibility for Medical Needs
The Undersigned assure Hood College that the Participant has consulted with a medical doctor with regard to the Participant’s personal medical
needs such that the Undersigned can and do further state that there are no health-related reasons or problems which preclude or restrict the
Participant’s participation in the Program. The Undersigned are aware of all applicable personal medical needs, as well as having arranged for
adequate hospitalization insurance to meet any and all needs for payment of hospital costs while the Participant is undertaking the Program. The
Undersigned agree that Hood College cannot be and is not responsible for attending to any of the Participant’s medical or medication needs, that
the Undersigned assume all risk and responsibility therefore, and that if the Participant is required to be hospitalized while in a foreign country or in
the United States during the Program, Hood College cannot and does not assume any legal responsibility for payment of such costs.
4.0 Participant’s Life, Health, and Property Insurance
The Undersigned are aware that there are other potential risks in which the Participant may be placed or in which the Participant may place himself,
herself or themselves during the Program which neither the Undersigned nor Hood College are able to foresee at this time. The Undersigned are
aware that life, health, and property insurance is sold by American companies in order to remove such risks and pool such risk of loss with others.
5.0 Hood College’s Rights and Powers
5.1 Hood College reserves the following rights and powers:
5.1.1 The right to cancel the Program without penalty;
5.1.2 The right to alter or withdraw any part of the Program and to make any alterations, deletions or modifications in
the itinerary and/or academic program as deemed necessary by Hood College or by the course instructors as agents of Hood College.
5.2 The Undersigned have made themselves aware of the rules and regulations as contained in the Hood College Student
Handbook and all relevant Hood College study abroad documents. The Participant agrees to uphold individual and group standards appropriate to
the cultural setting of the Program. If the Participant’s actions violate local or national laws and/or Hood College or host institution regulations, or
are judged to be injurious to the Program and/or seriously offensive to the host cultures, and/or damaging to the reputation of Hood College, the
Participant acknowledges that the faculty leader(s) and/or the study abroad director(s) have the right, after consultation with the Dean of the
College to terminate the Participant’s enrollment in the Program without refund of tuition nor fees and to return the Participant to the United
States at his own expense. The Undersigned understand that military actions, terrorist threats, labor strikes, civil unrest, and natural disasters as
well as other situations which are disruptive to the learning environment and/or the life of and safety of the Program group may result in an
alteration in the Program itinerary. The Undersigned agree to accept financial responsibility for the Participant which may result from such a
change in the Program itinerary and agree to follow the leadership and direction of Hood College in the decision to change travel plans.
6.0 Potential Travel and Accommodation Problems
6.1 The Undersigned acknowledge and agree to accept all responsibility for loss or additional expenses due to delays or other
changes in transportation due to sickness, weather, strikes, or other unforeseen causes. The Undersigned acknowledge and understand that Hood
College assumes no liability whatsoever for any loss, damage, destruction, theft, or the like to the Participant’s luggage or personal belongings, and
that the Participant has retained adequate insurance or has sufficient funds to replace such belongings and will hold Hood College harmless
therefrom. The Undersigned acknowledge and understand that in the event the Participant becomes detached from the Program group, fails to
meet a departure bus, airplane, or train, or becomes sick or injured, the Participant will bear all responsibility to seek out, contact, and reach the
Program group at its next available destination; and that the Participant shall bear all costs attendant to contacting and reaching the field trip group
at its next available destination. The Undersigned acknowledge and understand that there are risks associated with operating a motor vehicle while
participating in the Program and that Hood College assumes no liability whatsoever for any death, injury, damage, loss, accident, or delay resulting
from the Participant’s operating a motor vehicle while participating in the Program. All services and accommodations are subject to the laws of the
country in which they are provided.
6.2 The Undersigned understand that Hood College in no way represents or acts as agent for the transportation carriers, hotels,
and other suppliers of services connected with the Program. The Undersigned further understand and agree that Hood College, its governing board,
employees, and agents are:
6.2.1 Not responsible or liable for any injury, damage, loss, accident, delay, or other irregularity which may be caused by
the defect of any vehicle or the negligence or default by any company or person engaged in providing or performing any of the services involved in
the Program;
6.2.2 Not responsible for any disruption of travel arrangements or any consequent additional expenses that may be
incurred therefrom.
7.0 Legal Problems
The Undersigned acknowledge and understand that should the Participant have or develop legal problems with any foreign nationals or
government while participating in the Program, the Participant will attend to the matter personally with the Participant’s own personal funds. Hood
College is not responsible for providing any assistance under such circumstances.
8.0 Conduct of the Participant
The Undersigned are aware of the means by which sexually transmitted diseases are contracted and recognize the inherent risks of
unprotected sexual activity and intravenous drug use. The Undersigned are aware of the health, safety, and legal implications associated with the
use of alcohol and drugs and will educate themselves, prior to departure, as to the local or national laws of the host country. The Undersigned
acknowledge and understand that Hood College assumes no liability whatsoever for any death, injury, loss, damage, harm, accident, or delay
resulting from the Participant’s conduct as described above.
9.0 Governing Law
The Undersigned agree that this Agreement and General Release shall be construed in accordance with the laws of the State of Maryland, which
shall be the forum for any lawsuits filed under incident to the Agreement and General Release or the Program. The terms and provisions of this
Agreement and General Release shall be severable, such that if a court of competent jurisdiction holds any term to be illegal, unenforceable, or in
conflict with any law governing this Agreement and General Release, the validity of the remaining portions shall not be affected thereby.
10.0 Assumption of the Risks Involved
10.1 Knowing the dangers, hazards, and risks described herein, or otherwise associated with participation in the Program, whether
foreseen or unforeseen, and in consideration of being permitted to participate in the Program, the Undersigned, on behalf of the Participant’s
family, heirs, and personal representative(s), agree to assume all risks and responsibilities surrounding Participant’s participation in the Program,
including transit to, during, and from the Program, and to forever discharge, release, and waive any claims against Releasees for any and all liability
related to any harm, injury, damage, claims, demands, actions, causes of action, costs, and expenses of any nature whatsoever which the Participant
may have or which may hereafter accrue to the Undersigned, arising out of or related to any loss, damage, or injury, including but not limited to,
suffering and death, that may be sustained by the Participant or by any property belonging to the Participant, except for loss or injury arising out of
the sole negligence or willful misconduct of the Releasees.
10.2 The Undersigned understand and agree that Releasees do not have medical personnel available at the location of the
Program, during transportation, or anywhere in the Host Country. The Undersigned understand and agree that Releasees are granted permission to
authorize emergency medical treatment, if necessary, and that such action by the Releasees shall be subject to the terms of this Agreement and
General Release. The Undersigned understand that Releasees assume no responsibility for any injury or damage which might arise out of or in
connection with such authorized emergency medical treatment.
11.0 Academic Program
The Undersigned will comply with any special instructions or directions of an academic nature particular to this study abroad experience, including
attendance at mandatory pre-study-abroad orientations, completion of all required pre-departure paperwork, and completion of an evaluation at
the end of the program. The Undersigned will attend all lectures, museums talks, field trips, and special excursions as necessary requirements for
credit on this study abroad experience.
12.0 Early Return
The Undersigned understands that if he/she/they is/are required to return to the United States before the originally scheduled departure,
he/she/they will do so at his/her/their own cost. Possible reasons for return include but are not limited to: violations of the Code of Student
Conduct, premature end to the program, or US State Department travel warning for the location of the study-abroad program.
13.0 Participation in Program
The Undersigned plans to participate in a study abroad program, scheduled for ______________________ (dates/duration). The Undersinged has
voluntarily elected to participate in this study abroad program. This experience may transfer, as a part of the Hood College curriculum, as academic
credits. The Undersigned agrees to pay normal tuition costs (when applicable) to Hood College for a partnership program, or full tuition at a non-
partnership school and that all other travel, room, and board expenses will be the Undersigned’s responsibility.
14.0 Use of Photographic Likeness
The Undersigned further agrees that Hood College may release his/her/their photographic likeness on the College’s website or for publicity
purposes.
15.0 Other Claims
It is the Undersigned’s expressed intent that this Agreement and General Release shall bind the members of the Undersigned’s family and spouse, if
Participant is alive, and Participant’s family, estate, heirs, administrators, personal representatives, or assigns, if Participant is deceased, and shall be
deemed as a Release, Waiver Discharge, and Covenant not to sue the above-named Releasees. The Undersigned or Participant’s family, arising out
of the Participant’s participation in the Program.
Participant (Print): _______________________________ Date: _____________
Participant (Sign): ________________________________ Date: _____________
Parent/Guardian of Minor (Print): _____________________________________ Date: _____________
Parent/Guardian of Minor (Sign): ______________________________________ Date: _____________
SHORT-TERM/FACULTY-LED STUDY ABROAD GUIDELINES
*** Note: Study Abroad Procedures pages 7-8 are to be kept by the student! Do NOT turn them in to the
Director of Study Abroad ***
Hood College students participating in a short-term/faculty-led study abroad program should complete the
steps outlined below. Any student applying to a study abroad for any length of time must be in good
standing with the College and must have at least a 2.0 cumulative grade-point average. Students must be at
least a rising sophomore to participate in short-term study abroad programs.
REVIEW THE STUDY ABROAD PROGRAM
Students should thoroughly inform themselves about the study abroad program. Obtain information about
the program from the faculty organizers, learn about the study abroad provider if the program is organized
through a company, and meet with the Study Abroad Director at the College. Students should also carefully
examine the application procedures, travel dates, costs for travel to and at the proposed destination, cost
of meals and hotels or hostels, and cancellation policies.
GET ADVISED
Once the student has chosen to participate in the study abroad program, he/she/they should contact the
Director of Study Abroad to set up an advising appointment. During this meeting the Director will provide
the student with the short-term/faculty-led study abroad application form and the general release.
NECESSARY DOCUMENTS
There are a number of important documents that students participating in short-term/faculty-led programs
must submit to the Director of Study Abroad:
Study Abroad Check List (see attached), completed and signed
• Study Abroad Application – “short-term/faculty-led,” with signed Release Agreement.
• Proof of current medical insurance
• Copy of all flight information to and from the host destination
Passport: During the application process, a valid passport will need to be secured, and a COLOR
photocopy of the first page is recommended for the files in the Study Abroad Office. The passport must
be valid for 6 months beyond the last date the student expects to travel abroad.
Visa(s): If a student visa is needed for the study abroad destination, obtaining one is the student’s
responsibility, and students work directly with the appropriate consulate (or external agency that will
provide the visa) in obtaining one. The Study Abroad Office must be kept informed of progress in
obtaining it from the respective consulate.
STUDY ABROAD SCHOLARSHIPS
Participating in studying abroad is an investment in your future and involves a commitment to advanced
planning, careful time and money management, creativity, and perseverance. Financing this experience is
an integral part of that investment. The personal, academic, and professional rewards will last a lifetime.
Financial aid does not apply to short-term programs offered during the summer term. However, there are
various scholarships available that can help make the experience less financially stressful. Sources to
support study abroad can be found in the Study Abroad Office, researching grants or scholarships given by
the selected host college abroad, or by securing student loans in the financial aid office.
Outside scholarships are not connected to any specific Hood College programs, but can be applied for
independently by any student. Most scholarships are only awarded for semester or year-long study and are
highly competitive. Many of these have very specific, detailed application requirements, so research the
options and apply early.
Hood College offers the Shirley Conner Hardinge and Susan Whaley Study Abroad Scholarships: Students
who wish to apply for these scholarships must have at least a 2.5 GPA, and must not be on academic
probation. Students must also have his or her or their FAFSA filed with Hood’s Financial Aid Office. Fall
application for Spring 2019 is due October 31. Spring application for summer and fall 2019 is due March 16,
2018.
*** Note that deadlines for many of these scholarships close early – sometimes more than a semester
before the study abroad term – so plan accordingly. ***
OBTAIN MEDICAL AND SUPPLEMENTAL TRAVEL INSURANCE FOR THE TIME ABROAD
Hood College requires all students who study abroad to maintain health insurance that covers them in their
destination abroad for the entirety of their program period. Each student must determine how s/he/they
will be covered for health insurance while abroad either by calling their insurance company to inquire
whether s/he/they will be covered or by reviewing the existing policy documents.
In addition, Hood College requires that every study abroad participant must have insurance to cover any
and all expenses that might occur due to such injury as might require immediate return to the student’s
country of residence for care or for untimely death abroad, commonly called evacuation and repatriation
insurance. The college strongly recommends that students purchase supplemental insurance and can offer
guidance on a variety of policies and providers.
It is the student’s responsibility to provide the Study Abroad Office with proof of domestic health insurance
as part of the pre-program documentation requirements.
The College also strongly recommends that students also purchase supplemental travel insurance that
covers costs for trips cancelled because of illness and other emergencies, and which typically delayed or
cancelled flights, hotel or hostel cancellations, and lost or damaged luggage.
UPON YOUR RETURN
Upon return from the program abroad, complete a Study Abroad Evaluation Form (available from the
Career Center). After that form is completed, make an appointment with the Director of Study Abroad
located in Tatum 220 for an exit interview. Appointments may be made via email at
pincikowski@hood.edu. It is best to complete this final task as soon as possible, so the study abroad
experience is still fresh in mind.
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SHORT-TERMFACULTY-LED STUDY ABROAD APPLICATION Instructions: Complete the Application (Hood College)

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Completed 23 July 2020

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