Fillable Study Abroad Application Form Fillable Form (Saint Michael's College)

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Study Abroad Application Form Fillable Form (Saint Michael's College)

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Today’s Date _____________________________
Name_________________________________ ID#_________________ Year of Graduation ____________
Cell #_____________________ Home #_____________________ Campus Box # ________________
Major(s):____________________________________ Minor(s): ____________________________________
Period of Study Abroad: Fall 20_____ Spring 20_____ Winter 20_____ Summer 20_____
Name of Partner Program: _________________________________________________________________
Name of University or Program Title: _________________________________________________________
Study Abroad City and Country:______________________________________________________________
A. Courses in your Major(s) or Minor(s) Chair of Department
Number Name Will Transfer As… Initials Credits
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
B. Core Courses/General Education Requirements Registrar’s Office
Number Name Will Transfer As… Initials Credits
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
____________ _______________________ _______________________ ________ ________
C. General Elective Courses Registrar’s Office
Number Name Initials Credits
____________ _________________________________________________ ________ ________
____________ _________________________________________________ ________ ________
____________ _________________________________________________ ________ ________
____________ _________________________________________________ ________ ________
____________ _________________________________________________ ________ ________
APPROVED BY_________________________________ ENDORSED BY _______________________________
Major Advisor Department Chair (*Advisor for BU/AC Majors)
____________________________________ __________________________________
2
nd
Major Advisor 2
nd
Major Chair
STUDY ABROAD COURSES
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Nam
e
:
Major:
Major:
Minor: ____________________
Advisor:
Advisor:
Minor:
I. MAJOR COURSES (list all)
COMPLETED
COURSES
CURRENT
SEMESTER
COURSES
STUDY
ABROAD
COURSES
TO BE
COMPLETED
SPECIAL NOTES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
II. CORE
CURRICULUM
COMPLETED
COURSES
CURRENT
SEMESTER
COURSES
STUDY
ABROAD
COURSES
TO BE
COMPLETED
SPECIAL NOTES
CORE REQUIREMENTS
(4 courses)
1. First Year Seminar
2. 100-Level Philosophy
3. 100-Level Christian Traditions
and Thought
4. Junior Seminar
INTELLECTUAL
EXPLORATION (4 courses)
1. Literature and the Arts
2. History and Society
3. Scientific Inquiry
4. Quantitative Reasoning
PLAN FOR GRADUATION
III. SECOND MAJOR
COMPLETED
COURSES
CURRENT
SEMESTER
COURSES
STUDY
ABROAD
COURSES
TO BE
COMPLETED
SPECIAL NOTES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
IV. MINOR
1.
2.
3.
4.
5.
Complete information
below:
128 credits are required to graduate. The number of credits earned by the end of the current semester: _____________________
The number of credits remaining to complete: ______________
Current Overall GPA: (
3.0
required)
Advisor’s Signature:___________________________________________________ Date:_____________________________
2nd Major Advisor’s Signature:_________________________________________ Date:
Registrar’s Office Approval: ________________________________________ Date:
II. CORE
CURRICULUM
(continued)
COMPLETED
COURSES
CURRENT
SEMESTER
COURSES
STUDY
ABROAD
COURSES
TO BE
COMPLETED
SPECIAL NOTES
EDMUNDITE TRADITION
(2 courses)
1. Catholic Intellectual Tradition
2. Engaging Diverse Identities
BACHELOR OF ARTS
STUDENTS (2 courses)
1. First Semester of Language
2. Second Semester of Language
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Personal Statement
The Personal Statement is a critical component of the application process as it is the primary means by
which the applicant communicates a) the academic appropriateness of the proposed program of study,
and b) his/her preparedness for living and learning overseas. As with any formal piece of writing, the
personal statement should be proofread and free of errors before submission. The essay should be
typed, single-spaced and no more than 2 pages in length.
Instructions
Students who fully engage in the study abroad experience will be rewarded with unique opportunities
for personal growth, academic achievement, and increased cultural awareness. With these goals in
mind, incorporate into your personal statement thoughtful answers to the questions below. An essay
that fails to address these questions will be returned to the applicant.
1. How will participation in your proposed study abroad program contribute to your overall academic
goals and objectives? Include in your discussion an overview of how the classes you plan to take (or the
program in which you plan to participate) relate to your major, minor or demonstrated academic
interests.
2. The Mission and Vision Statement of Saint Michael’s College appears at the bottom of the page. How
does study abroad (and specifically your proposed plans for next semester) contribute toward these
central institutional goals?
3. What aspects of your new host country and culture are you most interested in learning about and
experiencing? What facets of your own culture are you looking forward to sharing with your host
community?
4. If you are concerned about conditions or situations that could impact the outcome of your application
(e.g. disciplinary record, GPA), address those concerns briefly in the essay.
Mission and Vision Statement
It is the Mission of Saint Michael’s College to contribute through higher education to the enhancement of
the human person and the advancement of human culture in light of the Catholic faith.
Vision:
• To actively engage students with ideas developed over millennia in many world civilizations as
well as those ideas from more recently emerging disciplines and assist students in the generative process
of creating new understandings. For this engagement to be most productive requires that a student work
closely with a faculty member who is deeply, actively, and demonstrably engaged in learning, for in a
liberal arts college it is not so much acquired knowledge or personal belief that is passed on from one
generation to the next, but rather curiosity and passion for the very ideas of the discipline.
• To encourage the development of an empathetic understanding and respect for the differing
views of others derived from their history, status or unique philosophical or religious belief. Such an
understanding is to be developed through proximate experience grounded in religious, philosophical and
historical contexts.
• To take responsibility for the moral and spiritual development of each individual by employing the
long Catholic intellectual tradition that sees no conflict between belief and reason. This is rooted in the
belief that the world is “good” and that the dignity of each person needs to be acknowledged.
International Study Agreement
Date:
I, ______________________________, agree to fulfill all academic and financial obligations incurred while participating in
any international study program and I understand that failure to do so may affect my education abroad status and/or my
status at Saint Michael’s College. In exchange for being allowed to participate in Saint Michael’s College’s international study
program (“program”), I further acknowledge that I understand, and agree to, the following conditions:
1. ADMISSION. I shall qualify for admission to the program by satisfying all educational requirements, including, but not
limited to, the GPA requirements for Saint Michael’s College and my program, adhering to the Student Code of
Conduct, and the payment of applicable tuition and fees relevant to a program.
2. RELE
ASE OF INFORMATION. I give permission to Saint Michael’s College to obtain and release information to the
host institution or third party agency as is appropriate to my application and participation in a program including:
letters of recommendation, permanent academic records, and other similar records for the purposes of placement,
participation, continuation or termination.
3. PROG
RAM PARTICIPATION. I understand that my participation in any program is contingent on my maintaining all
eligibility requirements prior to and during the period of the program. If eligibility is not maintained, Saint Michael’s
College or the host institution may terminate my participation in the program.
4. ACA
DEMIC EXPECTATIONS. I will enroll in the required number of credit hours (or equivalent) to maintain both
good academic standing while participating in the program and the visa or entry clearance requirements per my host
country. I understand that failure to do so may jeopardize my participation in a program as well as my academic
record at Saint Michael’s College. I am responsible for submitting all forms required by Saint Michael’s College and
the host institution for each course for which transfer credit will be requested. I understand that additional information
may need to be provided at the completion of the program before final credit approval is granted. I understand that
course pre-requisites required by Saint Michael’s College and the host institution must be met and that course
registration at the host institution is based on availability of offerings and cannot be guaranteed.
5. PER
SONAL CONDUCT. I agree to conform to all applicable rules, regulations and policies of Saint Michael’s
College as outlined in the SMC Student Handbook and by the Study Abroad Office materials, the host institution, the
host country, and any third party agency.
I understand that Saint Michael’s College has the right to withdraw a student from a program at any time because of
violation of such rules, disruptive behavior, academic reasons, or for conduct that could, in the College’s judgment,
bring the College into disrepute or legal jeopardy. Such decisions will be final and no refund will be made. I agree
that I will not attempt to hold the College liable for any claims incurred by reason the College’s decision to withdraw
me from a program.
6. PROG
RAM CHANGES. I understand and agree that any information about a particular program provided by Saint
Michael’s College, while based on Saint Michael’s College’s best information and belief, is descriptive only. Saint
Michael’s College reserves the right to make changes in any published itinerary whenever, in Saint Michael’s
College’s judgment, conditions warrant, or if Saint Michael’s College deems it necessary for the comfort,
convenience or safety of participants.
7. TRA
VEL. I understand that I will be traveling during the program by various modes of transportation including, but
not limited to, plane, train, bus or van. I hereby release Saint Michael’s College, its employees, agents, trustees, and
staff from any loss of property, injury or death during such travel.
8. MEDICAL TREATMENT. I agree that I am responsible for any medical treatment of any nature that I may require
and I agree to accept all financial responsibility for such treatment. I have had an opportunity to consult with a
medical doctor with regard to my personal medical needs. I certify that there are no health-related reasons or
problems that preclude, restrict or recommend against my participation in a program, with or without reasonable
accommodations. If I intend to seek reasonable accommodations in order to participate in a program, I agree to
make such requests to my program provider in an appropriate timeframe prior to my departure and comply with all
program policies and processes relating to accommodation requests. I understand that failure to provide information
in a timely manner may delay or prevent the program from providing reasonable accommodations where necessary.
I agree that Saint Michael’s College may (but is not obligated to) take any actions it considers to be warranted under
the circumstances regarding my health and safety, and hereby grant permission to the College to do so. I agree to
pay all expenses related thereto and hereby release Saint Michael’s College from any liability for any such actions. I
agree that Saint Michael’s College may also contact my parent(s) or other designated emergency contact(s), and
disclose otherwise confidential or private information, including, but not limited to, medical information if such
disclosure is necessary or desirable in order to assist or resolve an emergency involving me while participating in a
program.
9. INSURANCE COVERAGE. I understand that I am required to maintain adequate health, accident, disability,
hospitalization, and travel insurance during the enrollment period. I am responsible for filing and negotiating all
insurance claims directly with my insurance company or companies in the event necessary.
10. ACKNOWLEDGMENT AND ASSUMPTION OF RISK, GENERAL RELEASE AND WAIVER. I hereby acknowledge
that travel abroad and participation in a program entails risks not found in study on U.S. campuses. I acknowledge
and understand that these may include, but are not limited to, risks involved in or from: travel; different political, legal,
social, law enforcement, and economic conditions; different standards of design, safety and maintenance of
buildings, public places and conveyances; different standards as to the availability and provision of medical care;
different weather conditions; and different educational systems, academic expectations, recognition of civil rights,
lack of accessibility for individuals with disabilities, alcohol and drug use, and gender-related issues. I have made
inquiry regarding such risks by consulting, for example, resources such as State Department Travel Advisories and
Consular Information Sheets, and hereby acknowledge and assume all such risks as a condition of my voluntary
participation in a program. I hereby release and waive any and all claims of any description that I or my family
members or personal representatives have or may ever have against Saint Michael’s College and/or its staff,
employees, agents, attorneys, and Board of Trustees (“Released Parties”) that arises out of or in connection with my
participation in a program, and I expressly understand and agree to hold harmless, defend and indemnify the
Released Parties from any and all liability for inconvenience, damage to or loss of property, medical or hospital care,
or injury, illness or death and/or any other claim whatsoever that might be incurred during the period of and/or
connected with the program. I intend for these release, waiver and indemnity provisions to be effective in all
circumstances, including circumstances arising or allegedly arising out of the reckless or negligent actions or
inactions of any or all of the Released Parties.
11. LEGAL RESPONSIBILITIES. I understand that I must comply with the laws and appropriate cultural conduct of the
countries I am visiting. I agree to conduct myself in a manner that will comply with the regulations of my host
institution, program administrator(s), and Saint Michael’s College. If I experience legal problems with any foreign
nationals or governments, I will attend to the matter personally with my own personal funds. Saint Michael’s College
does not guarantee what, if any, assistance it can provide under such circumstances.
12. TUITION, FEES, AND REFUNDS. I understand that as a Saint Michael’s College student, I will pay Saint Michael’s
College study abroad fee while participating in a program. In addition, I understand that I am responsible for costs
not paid for by the College such as room and board, airfare, train fare, airline ticket change and baggage fees, trip
insurance, credit card “convenience fees,” vaccinations, single room surcharges, housing deposits, visa or passport
costs, passport photos, medical exams, in-country residence fees, early withdrawal fees, costs associated with
independent study projects and research, lab fees, cell phones, optional trips and events, books, gym membership
fees, travel and personal expenses.
Withdrawal, departure or dismissal from any program prior to its formal completion will result in forfeiting any
deposit(s) and will require that I pay all costs incurred. I understand and agree that if I withdraw, depart or am
dismissed from a program after the program begins, I may not be eligible for any academic credits associated and
could face disciplinary action from Saint Michael’s College.
13. RESPONSIBILITY DURING FREE TIME. I understand that during free time within the period of the program or
before or after the period of the program I may elect to travel independently at my own expense. If I choose to travel
after the completion of the program, I understand that any obligations of Saint Michael’s College shall cease. If I
choose to travel independently before, during or after the program period, I understand that Saint Michael’s College
has no responsibility with respect to such travel. I understand that any risky activity or travel in which I choose to
become involved outside of the program will be wholly at my own expense and risk. I understand and acknowledge
that while Saint Michael’s College employees may provide participants with information regarding extra-curricular
activities or travel, in no way does this represent a Saint Michael’s College endorsement of those activities or
destinations.
14. FAMILY INVOLVEMENT. I understand that it is my responsibility, to provide my parents/guardians/significant others
with important information about my involvement in any program and/or travel. I give permission to Saint Michael’s
College to share information with my parents or guardians as necessary for my health and safety in the sole
judgment and discretion of Saint Michael’s College.
15. USE OF PHOTOGRAPHS OR WRITTEN REPORTS: I authorize and agree to the reasonable use by Saint
Michael’s College of any photographs that may be taken of any aspect of the program and may include my image, as
well as any written comments or reports submitted to Saint Michael’s College by me.
16. CHOICE OF LAW. The laws of the State of Vermont shall govern the validity of this Agreement, the construction of
its terms and the interpretation of the rights and duties of the parties hereto.
17. HEADINGS. Section headings are not to be considered a part of this Agreement and are not intended to be a full
and accurate description of the contents hereof and are for convenience only.
18. WAIVER. Waiver by one party hereto of breach of any provision of this Agreement by the other shall not operate or
be construed as a continuing waiver.
19. INVALID PROVISIONS. If any provision of this Agreement, or any portion thereof, is held to be invalid and
unenforceable, then the remainder of this Agreement shall nevertheless remain in full force and effect.
IN WITNESS WHEREOF the undersigned have executed this Agreement as of the day and year first written above. The
parties hereto agree that facsimile signatures shall be as effective as if originals.
SEMESTER/YEAR
: _______________________ Study Abroad Destination: ______________
PARENT or OTHER LEGAL GUARDIAN STUDENT
______________________________________ ____________________________________
Signature Signature
______________________________________ ____________________________________
Print Name Print Name
______________________________________ ____________________________________
Address Address
_____________________________________________ _____________________________________________
Phone Email Phone Email
In case of emergency, contact:
______________________________________ ____________________________________
Name Relationship
______________________________________ ____________________________________
Address Area Code and Phone Number – cell and home
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Complete & Submit to the SMC Registrar’s Office
Klein Building, Suite C
TRANSCRIPT REQUEST FORM
FOR STUDY ABROAD APPLICATIONS
Submit to: The Registrar’s Office, Klein Building, Suite C
NAME: _________________________________________ ID Number: _____________________
Campus Box Number: _________________________ Class Of: _______________________
Cell or Local Phone: _________________________ E-Mail: ______________________
1. STUDY ABROAD PROGRAM APPLICATION
Mail my Official Transcript to my Study Abroad Partner Program:
Name of Program: ______________________________________________________
Street Address: ______________________________________________________
City/State/Zip: ______________________________________________________
Hold for Final Grades
Send Immediately
2. SAINT MICHAEL'S COLLEGE APPLICATION
Send an unofficial copy of my transcript to the Director of Study Abroad, Box 112.
________________________________________________ __________________
Student Signature Date
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Study Abroad Application Form Fillable Form (Saint Michael's College)

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Completed 24 July 2020

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