Registration Form FUBiS Term II 2010

Transcription

1 Registration Form FUBiS Term II 2010 Freie Universität Berlin International Summer and Winter University (FUBiS) May 29 July 10, 2010 Application Deadline: March 5, Payment Deadline: April 1, 2010 Please complete this application form using your computer and send it to the following address. Information marked with an * is mandatory. Kim Foote, Study Abroad Advisor 64 W. 11 th Street, Rm. 108 New York, NY Tel x2260 Fax: footek@newschool.edu 1. Personal Information Ms. * Mr. * Family name* First name* Postal Address Street* Street 2 or Apt # City* State Zip / Postal Code* Country* * Telephone* Fax number (Day/Month/Year) of Birth* e.g.: 23 February 1983 Citizenship* Passport Number * Emergency Contact Information* Name* * Telephone Number*: + (country code) + (area code) + 2. Academic Information* Please note that credits can only be awarded if you are currently / have been enrolled at a university. Complete (!) name of current or former Home College / University* in national language e.g.: Università degli Studi di Parma City of Home College / University* e.g.: Parma Major* Minor* I am a/n (1 st, 2 nd, 3 rd, 4 th year student; graduate student, Ph.D. student, alumni)* Registration Form FUBiS Term II 2010 page 1 of 5

2 Does your home university accept the credits and grades you will receive at FUBiS? Yes No I don t know does not apply Are you planning to transfer these to your home institution? Credits: Yes No Not yet decided does not apply Grades: Yes No Not yet decided does not apply How did you learn about FUBiS?* Internet Professor Study Abroad Office FUBiS alumni Other; please identify: 3. Course Selection* Please select either one or two courses by indicating your choice with the course number. A Track and B Track courses can be combined. Lang students are expected to enroll in MUSIC IN BERLIN. Maximum total credits for Lang students: 10 if or 12 if adding an additional course from Summer Term II or III. The maximum enrolment is 18 students for subject courses and 15 students for German language courses. If your choices cannot be accommodated because the course is already fully booked, FUBiS will contact you to discuss alternative options. Please note that C track and D track courses cannot be combined with any other course. For the Music Composition course (B track, No. 2.12) please apply with an extra form that can be downloaded on the FUBiS homepage Track A and/or Track B or Track C or Track D FUBiS Term II 2010 Course Listings Track A Monday & Thursday Tuition 1,200 # Title Language Hours ECTS 2.01 Transatlantic Relations English Mass Media and Popular Culture in Berlin English Music in Berlin: Three Centuries of Tradition and Innovation English 72 6 Track A Monday, Wednesday & Thursday Tuition 1, Semi-Intensive German Language Beginner Semi-Intensive German Language Beginner Semi-Intensive German Language Intermediate 1 German Semi-Intensive German Language Intermediate Semi-Intensive German Language Advanced 1 Track B Tuesday & Friday Tuition 1, Deutsche Exilliteratur: Thomas Mann, Bertolt Brecht, Theodor W. Adorno German Understanding the European Union: Internal and External Affairs English Exploring Contemporary Germany and Berlin English Music Composition: Compose, Rehearse & Perform English Berlin - a Tale of More Than Two Cities English Espionage in the 20th Century English Borders & Crossings: Romanticism to the Present English Representing the Nation: Art and Architecture of Berlin English 72 6 Track C Monday through Friday Tuition 1, Intensive German Language Beginner Intensive German Language Beginner Intensive German Language Intermediate 1 German Intensive German Language Intermediate Intensive German Language Advanced 1 Track D Monday, Tuesday, Thursday & Friday Tuition 1, Sustainability Law and Governance (July 4 18, 2010) English Payment and Registration The full amount indicated in the invoice is due for payment by April 1, A place in the program can be guaranteed only after all fees have been received in the FUBiS bank account listed in the invoice. There will be a fee of 75 charged for each change of course after registration. The program fee and the late registration fee are not refundable. For cancellations made before May 2, 2010, FUBiS will refund tuition fees. Any transaction fees applicable to refund transactions (bank transfer or credit Registration Form FUBiS Term II 2010 page 2 of 5

3 card) have to be paid by the participant. For cancellations made after May 2, 2010, no fees and tuition are refundable. In this case participants are requested to contact the FUBiS office. For more details, please refer to the FUBiS General Terms and Conditions at Program fee The Program fee includes: - Access to libraries, computer, Internet, and printing facilities on campus - Student ID (for reduced meals, reduced entrance fees, e.g. in museums) - One transcript to be sent to student s home address or home institution - Two extra-curricular Berlin activities: Boat Trip and guided tour through Reichstag Tuition: First course A or B Track 1,200 Second course B or A Track 1,200 Intensive course C Track 1,800 Intensive course D Track 1,200 Will you receive a scholarship? No Yes If yes, please identify: Are you a FUBiS alumni? No Yes If yes, please identify (year, term): Additional Services: The following optional services can also be booked through FUBiS: 5. Accommodation Freie Universität Berlin like most German universities does not own any student dorms or housing facilities. FUBiS arranges appropriate off-campus accommodation for the duration of the program as an optional service at the student s request (provided there are spaces available). To make a housing arrangement, all fees indicated in the invoice have to be paid in full. For cancellations made until May 2, 2010, FUBiS will refund received rental payments. For cancellations after this date, rental payments might be refundable in exceptional cases only. The terms and conditions of the provider apply. In this case participants are requested to contact the FUBiS office. For more details, please refer to the FUBiS General Terms and Conditions at Please select: I would like to reserve a single room with shared facilities at a student dorm (Studentendorf Berlin-Schlachtensee or Studentenwerk Berlin-Lichterfelde). Shared bathroom and fully equipped kitchen. 510 I would like to reserve a furnished single occupancy apartment (in Berlin-Lichterfelde or Berlin-Mariendorf). Incl. kitchen, TV, balcony, coffee maker, radio etc. 680 I wish to apply for a homestay arrangement with a Berlin host family. (incl. breakfast & dinner seven days a week) 900 I hereby authorize FUBiS to arrange accommodation for the duration of the program. I am aware that FUBiS only serves as an intermediary. FUBiS is not liable for any agreement between the two parties of renter and landlord. Participant s signature I will find my own accommodation in Berlin. 6. Insurance coverage Or Or FUBiS Insurance Package for the duration of Term II 65 includes international health, accident and liability insurance FUBiS Liability Insurance for the duration of Term II 23 for students who already have a valid international health insurance Individual insurance for the duration of Term II I hereby confirm that I already have my own international health insurance or that I will take out my own insurance for the duration of the FUBiS program. Registration Form FUBiS Term II 2010 page 3 of 5

4 7. Excursions Daytrip to Dresden (June 12, 2010) 60 includes transportation, a guided city tour, an exclusive guided tour of the Semper Opera House Weekend excursion to Hamburg (June 19-20, 2010) 140 includes transportation, 1 night in a youth hostel incl. breakfast, 2-day-ticket for public transportation, guided city tour, boat tour around the harbour and a visit to a museum Weekend excursion to Weimar (June 26-27, 2010) 130 includes transportation, 1 night in a youth hostel incl. breakfast and dinner, guided city tour, guided tour of Goethe s house and a visit to the former concentration camp Buchenwald If there is a choice, I wish to take part in the guided tours held in: German English ***300 discount for Music in Berlin class fee for Lang students*** _- 300 Total in : Please convert to US Dollars using the exchange rate of 1 = 1.45 USD as a general guideline for the conversion. Amount will be confirmed by the payment deadline. Total in USD: 8. Methods of Payment Please complete the attached payment form (use only one if registering for both Term II and III). Payments acceptable by check, money order, or credit card. IF PAYING BY CREDIT CARD: I, the undersigned card holder, agree that all fees for registration, tuition, housing and other extras as indicated above will be withdrawn from my credit card by the Freie Universität Berlin International Summer and Winter University (FUBiS). Card holder s signature I hereby certify that the information on this registration form is complete and accurate to the best of my knowledge. I also declare that I have read, understand and accept the General Terms and Conditions and the FUBiS Program and Academic Policies as published at of Freie Universität Berlin. I understand that I am not insured through FUBiS against illness, injuries, or other damages which may occur during the FUBiS program if I did not choose the FUBiS Insurance Package (Section 6. Insurance coverage). Freie Universität Berlin holds no liability in case I am unable to complete the program due to an emergency. Participant s signature Registration Form FUBiS Term II 2010 page 4 of 5

5 Payment Form: FUBiS Program, Berlin, Germany May 29 July 10, 2010 (optional session July 17 August 14, 2010) The following form authorizes Eugene Lang College, The New School, to charge your credit card or extract payment from your checking account as payment for program fees for the FUBiS program in Berlin, Germany, from May 29 July 10, 2010, with an optional session July 17 August 14, Please enter your payment information: Name of Participant Form of Payment: Check/MO Visa MasterCard Amer. Express (Please make checks payable to The New School) Cardholder s Name: Cardholder s Address Credit Card Number: Exp. : Amount of Payment: (NOTE: due to fluctuations in the currency exchange rate, your amount will be confirmed by the payment deadline) Cardholder s Signature: : Return in person to: Kim Foote OR mail to: Academic Advising Office, Eugene Lang College, 64 W. 11 th Street, Rm. 108, New York NY ATTN: Kim Foote Phone: (212) x2260 Registration Form FUBiS Term II 2010 page 5 of 5