THE CENTER FOR GLOBAL EDUCATION & CITIZENSHIP

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1 THE CENTER FOR GLOBAL EDUCATION & CITIZENSHIP 2011 SUMMER FASHION PROGRAM STUDENT APPLICATION CHECKLIST To apply for the Summer Fashion Program, please submit the required documents to The Center for Global Education & Citizenship (CGEC), 2 nd Floor dehoernle International Center. Incomplete applications will not be accepted. Please see the steps below for detailed instructions. CHECKLIST Application (with all pages complete and all signatures required) Official Transcript Letter of Recommendation (from High School Guidance Counselor) STEP 1: APPLICATION Prospective students under the age of 18 must have both parents on the Summer Fashion Program application and Waiver of Liability. The completed application and waiver are to be mailed to: Center for Global Education & Citizenship Summer Fashion Program Lynn University 3601 N. Military Trail Boca Raton, FL STEP 2: OFFICIAL TRANSCRIPT Please request a copy of your official high school transcript to be sent to: The Center for Global Education & Citizenship Lynn University 3601 N. Military Trail Boca Raton, FL A minimum 2.3 cumulative GPA is required. STEP 3: ACCEPTANCE You will receive an notifying you of your acceptance or application status. Please note: Applications will not be evaluated for acceptance until the program minimum number of students has been met. The Center for Global Education & Citizenship 3601 N. Military Trail Boca Raton, FL Tel: Fax: Revised 3/17/11

2 THE CENTER FOR GLOBAL EDUCATION & CITIZENSHIP STEP 4: $500 DEPOSIT Once notified of acceptance, the $500 deposit must be made online ( The $500 deposit is non-refundable in all cases. STEP 5: PAYMENT Payment for the Lynn University Summer Fashion Program must be made online ( Upon acceptance into the program the payment deadline will also be confirmed through by the Center for Global Education & Citizenship. Please note that the final payment date will range between days from the program start date. STUDENT CANCELLATION POLICY All cancellations must be submitted in writing to The Center for Global Education & Citizenship and SAS. No refunds will be given after the payment deadline date. Prior to the payment deadline, unrecoverable costs already incurred by Lynn University on your behalf may be charged to your account. Please note the explanation of unrecoverable costs in the Refund Policy section. Once an applicant has been accepted to the Lynn University Summer Fashion Program, the University is required to make payment to the program provider and vendors on the applicant s behalf. STEP 6: IMPORTANT INFORMATION YOU NEED TO KNOW REFUND POLICY: Once a student has applied for and been accepted to the Lynn University Summer Fashion Program, the student is deemed enrolled in the Program. To withdraw from the Program, the student must notify The Center for Global Education & Citizenship in writing before the payment deadline date. All notices of withdrawals must be signed and dated. The Refund Policy is as follows: Cancelled Up to the Payment Deadline After the Payment Deadline Refund Full program fee, minus $500 deposit No refund In all cases, the $500 deposit is non-refundable. The Center for Global Education & Citizenship 3601 N. Military Trail Boca Raton, FL Tel: Fax: Revised 3/17/11

3 THE CENTER FOR GLOBAL EDUCATION & CITIZENSHIP Travel Arrangements, for Programs that DO NOT include a group flight You are responsible for making your own travel arrangements to and from the program destination, unless your program includes group flights with pre-arranged air travel. If arranging your own flight, you must arrive by the specified start date of the program. The cost of airfare is NOT included in the program cost. Please refer to the Center for Global Education & Citizenship for flight arrival and departure time parameters before booking your flight. Grades and Credits: All registration is handled by The Center for Global Education & Citizenship and the Registrar s Office. Your registration for the Lynn University Summer Fashion Program and your participation in the program are contingent upon satisfying all financial obligations. Please detach these cover sheets and keep for your records. The Center for Global Education & Citizenship 3601 N. Military Trail Boca Raton, FL Tel: Fax: Revised 3/17/11

4 Center for Global Education & Citizenship Lynn University Summer Fashion Program 2011 APPLICATION FOR ENROLLMENT Mother s Last Name Mother s First Name Mother s Middle Initial Father s Last Name Father s First Name Father s Middle Initial Guardian s Last Name Guardian s First Name Guardian s Middle Initial Custodial Parent/Guardian Home Address City State Zip Mother s Address Mother s Cell Phone Mother s Work Phone Father s Address Father s Cell Phone Father s Work Phone Guardian s Address Guardian s Work Phone Guardian s Cell Phone STUDENT INFORMATION Last Name First Name Middle Name Address Cell Phone Home Phone of Birth (Mo/Day/Yr) Academic Status High School (entering Sept. 2011) Junior Senior Cumulative GPA Are you a U.S. citizen? Are you an F-1 visa student? If you are a holder of a non-u.s. passport, which Yes No Yes No country is it from? Is there a court order restricting the visitation/or custody rights of either parent or anyone, with regard to? Yes No If yes, please provide a copy of the court order Daughter/Son name(s) EMERGENCY CONTACT INFORMATION Last Name First Name Relationship Street Address City State Zip Address Cell Phone Work Phone Home Phone Physician Name Telephone Revised 3/18/2011 Lynn University Center for Global Education and Citizenship 2 nd Floor DeHoernle International Center

5 Center for Global Education & Citizenship Lynn University Summer Fashion Program 2011 FIELD TRIP STATEMENT (SIGNATURE REQUIRED) I hereby grant permission for my daughter/son to attend any field trips on/off campus during the course of the Lynn University Summer Fashion Program. I understand this permission form is a general one that applies to all field trips throughout the program. PARENT S STATEMENT (SIGNATURE REQUIRED) I understand that because of the nature of some activities within the Lynn University Summer Fashion Program there is a potential for accidental injury. I do recognize these risks and agree to allow my daughter/son to participate in the Lynn University Summer Fashion Program activities. I agree to assume these risks and release and hold Lynn University, Inc., and its officers, trustees, employees and agents harmless from, and waive any claim against, Lynn University, Inc. as to any injury which may occur to my daughter/son, regardless of the cause, while attending the Lynn University Summer Fashion Program. I understand that I am financially responsible for all medical treatment and services rendered to my daughter(s)/son(s). Also, in the event my daughter(s)/son(s) sustains any injuries while in the Lynn University Summer Fashion Program, I hereby give my permission to any person employed by Lynn University, Inc. to seek whatever medical assistance he/she deems appropriate. I agree to hold the above employee(s) and Lynn University, Inc. harmless from any action in this respect. Lynn University, Inc. is hereby granted permission to use any individual or group photographs taken at Lynn University Summer Fashion Program showing my daughter/son in activities for publicity and brochure purposes. Revised 3/18/2011 Lynn University Center for Global Education and Citizenship 2 nd Floor DeHoernle International Center

6 Center for Global Education & Citizenship Lynn University Summer Fashion Program 2011 REFUND STATEMENT (SIGNATURE REQUIRED) I understand the following Lynn University Summer Fashion Program refund policy: Cancelled Refund Up to Payment Deadline After Payment Deadline Full tuition and program fee, minus $500 deposit No refund A non-refundable, nontransferable deposit of $500 per applicant is required with each application. All registration cancellations must be submitted in writing to the Center for Global Education & Citizenship. If a student chooses not to participate in a program activity, either mandatory or not mandatory, (such as a field trip, excursion, cultural event, meal, etc.), he/she will not be refunded any portion of the cost of the program. If the student is dismissed from the Lynn University Summer Fashion Program, he/she will receive no refund. I HAVE READ AND UNDERSTAND THE TERMS OF ENROLLMENT. (APPLICATION NOT ACCEPTABLE WITHOUT PARENT/GUARDIAN SIGNATURE.) Revised 3/18/2011 Lynn University Center for Global Education and Citizenship 2 nd Floor DeHoernle International Center

7 Center for Global Education & Citizenship Lynn University Summer Fashion Program 2011 Consent to Release Information I,, (student s name) understand that the Family Education Rights and Privacy Act of 1974 (FERPA), as amended, affords students the right to authorize the release of education information to third parties. I also understand that attending the program may involve circumstances which requires Lynn University, Inc. to disclose, exchange, or receive certain information to third parties, but for which it may be difficult to obtain without prior written permission. I consent for Lynn University, Inc. to release to my parent(s) or guardian(s) (sign your initials to any/all statements to which you agree): any and all information directly or indirectly related to my health, safety, or well being that it becomes aware of any and all information directly or indirectly related to my academic record, grades, registration, and disciplinary records any and all information directly or indirectly related to the financing of my education, i.e. bill and program fees I acknowledge and agree that Lynn University, Inc. is not required by virtue of my consent to release any information concerning me to any person but rather is permitted to release such information that it determines, in its reasonable discretion, is necessary or appropriate under the circumstances. Parent/Guardian Contact Information Contact (First Name, Last Name) Relationship to you Street Address City State Zip Address Cell Phone Work Phone Home Phone I understand that this consent may only be revoked in writing signed by me and received by the Center for Global Education and Citizenship, Lynn University, 3601 North Military Trail, Boca Raton, FL By signing below, I acknowledge that I have read and understood this Consent as it relates to me. (Applicant s Printed Name) (Applicant s Signature) () (Parent/Guardian Printed Name) () () (Parent/Guardian Printed Name) () () Revised 3/18/2011 Lynn University Center for Global Education and Citizenship 2 nd Floor DeHoernle International Center

8 Center for Global Education & Citizenship Lynn University Summer Fashion Program 2011 HEALTH INFORMATION LYNN UNIVERSITY SUMMER FASHION PROGRAM The purpose of this form is to help the Center for Global Education and Citizenship to be of maximum assistance to you should the need arise during the program. Mild physical or psychological disorders can become serious under the stress of life while traveling. It is important that Center for Global Education and Citizenship be made aware of any medical or emotional problems, past or current, which may affect you while on the program. It is sometimes difficult to share such information, but please understand that the timely disclosure of this information is intended solely to support your experience. The information provided will remain confidential and will only be shared with program staff, faculty, or appropriate professionals if pertinent to your own well-being. We may not be able to accommodate all individual needs or circumstances. This information does not affect your admission into the program. First and Last Name: Home Address: Number & Street City State/Country Zip Code address: Cell Phone Number: Program Title: Term/Year: of Birth: YES NO Medical History 1. Are you currently being treated or have you been treated within the past five years for a physical health condition, injury, or disease such as high blood pressure, back injury, MS or other condition? (If yes, please explain.) 2. Do you have any chronic health conditions, i.e., diabetes, asthma, seizure disorders? (If yes, please describe the treatment, including any medications and how you plan to manage your treatment overseas.) 3. Are you currently being treated or have you been treated within the past five years for a mental health condition, psychological or emotional, such as depression, anxiety, eating disorder, loss or grief? (If yes, please describe the treatment, including any medications that you are presently taking and/or have taken in the past. How do you plan to manage your treatment while on the program?) Revised 3/18/2011 Lynn University Center for Global Education and Citizenship 2 nd Floor DeHoernle International Center

9 Center for Global Education & Citizenship Lynn University Summer Fashion Program 2011 YES NO Medical History 4. Are you taking any medication (prescription, over-the-counter)? (If yes, please describe the condition for which you are taking the medicine and describe any medications that you are presently taking and/or have taken in the past. How do you plan to manage your treatment while on the program?) 5. Do you have any specific allergies or dietary restrictions? (If yes, please describe.) 6. Do you have any mobility or physical activity restrictions (due to a disability, obesity, or cardiac condition that may require accommodations* to fully participate in the program, etc.)? (If yes, please explain and attach relevant documentation.) 7. Do you believe you have a health condition or disability (i.e., learning disability, attention deficit disorder, diabetes, brain injury, epilepsy, or other) that may require reasonable accommodations* to fully participate in the program? (If yes, please explain and attach relevant documentation.) 8. Do you have a hearing or visual loss that may require reasonable accommodations* to fully participate in the program? (If yes, please explain and attach relevant documentation.) 9. Is there any additional information that would be helpful for the program to be aware of? (If yes, please explain.) * If yes, please contact the Center for Global Education and Citizenship as soon as possible to determine eligibility of reasonable accommodation. I certify that all responses on this Health Information form are true and accurate, and I will notify the Center for Global Education and Citizenship hereafter of any relevant changes in my health that occur prior to the start of the program. I understand that the Center for Global Education and Citizenship will do its best to accommodate my needs, though not all accommodations are possible. I also understand that I cannot expect accommodations for those situations that I have not disclosed. Applicant Signature Revised 3/18/2011 Lynn University Center for Global Education and Citizenship 2 nd Floor DeHoernle International Center

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