General Application U.S. Academic Host Institution DEADLINE FOR ALL HOST INSTITUTION APPLICATIONS: MARCH 21, 2014 Please indicate which IREX-implemented programs your institution is interested in hosting: Tunisia UGRAD (academic year) Kosovo UGRAD (academic year) Global UGRAD in Eurasia and Central Asia (academic year) Global UGRAD in Eurasia and Central Asia (semester) Global UGRAD-Pakistan (semester) All regions Please check the total number of students your institution is interested in hosting. 1 2 3 4 5 6 7 8 9 10 GENERAL INFORMATION Name of Institution: Principal Contact Person for the Application: Full Name: Title: Name of Department: Role in UGRAD Program Administration: Address: Telephone: Fax Number: E-mail: Proposed Host Advisor for the UGRAD Program(s): (if different from above): Full Name: Title: Name of Department: Address: Telephone: Fax Number: E-mail: 1 P age
IMPORTANT DATES FOR 2014-2015 What type of academic schedule does your institution follow (please check one): semester trimester quarter Dates for Fall 2014: International Student Orientation: Fall Registration Deadline: Fall Add/Drop Deadline: First Day of Fall Semester 2014: Last Day of Fall Semester 2014: Move-Out Day: Dates for Spring 2015: International Student Orientation: Spring Registration Deadline: Spring Add/Drop Deadline: First Day of Spring Semester 2015: Last Day of Spring Semester 2015: Move-Out Day: ***When listing the last day of the semester, please be sure to include the week of final exams*** Please provide a link to your Academic Calendar: ACADEMIC INFORMATION AND SUPPORT Please provide your institution s overall TOEFL requirement and subscore requirements, if applicable: Minimum Total TOEFL Score: Minimum Subscore: Reading: Minimum Subscore: Listening: Minimum Subscore: Writing: Minimum Subscore: Speaking: Some UGRAD students take the Institutional TOEFL 1 exam as part of their selection process. Please indicate if the Institutional TOEFL exam is sufficient for enrolling non degree-seeking students in your institution. Yes No 1 The Institutional TOEFL exam is given to finalists of the Global UGRAD-Pakistan and Tunisia UGRAD programs only. The Institution TOEFL exam is used for large groups of exchange participants, as it can be administered at the same time and place for many participants. Paper TOEFL exams are provided by ETS and returned to them for scoring; the exam itself is conducted, using precise instructions, by the organization to which the Institutional TOEFL exams have been released. 2 P age
Do you require additional placement testing? Yes No If yes, please list tests required and class restrictions/requirements: Can students pre-register for classes? Yes No Please list all fields of study your institution would be interested in hosting. Each field listed must: Have enough courses available for students to fulfill UGRAD requirements (i.e. all students courses must be in-person courses, and half of student courses for each semester/quarter must be in their field of study) Allow for non-degree, non-major students to take courses in this field (w/o prerequisites) Please provide a link to your institution s website showing all undergraduate fields of study. Please list at least three fields of study that typically offer the most course options per semester? (In what fields does your institution specialize?) Which fields have the most restricted courses of study? (ex. only online course offerings, restrictions for non-degree students to register, higher TOEFL requirements, etc.) Please list special student academic support services that are available on your campus (ex. writing center, computer classes, peer tutor program, etc.), including appropriate program website links, if applicable. If your institution has English as a Second Language programs or types of English-support programs, please briefly describe the offerings and provide appropriate program website links, if applicable. 3 P age
ACADEMIC SKILLS BUILDING The Global UGRAD-Pakistan and Tunisia UGRAD have a required academic skills building component. Tunisia UGRAD students are required to participate in one ac ademic skills building course or training series during their first semester. Global UGRAD-Pakistan students may either participate in a course or training series, or participate in the Critical Study Skills Program. Under this program, the host institution designates a mentor to work with their assigned student in developing an individualized plan for addressing the student s greatest areas of need. Mentors will tutor their students for two hours per week for the first six weeks of the semester in critical study skills. Please list and describe any academic skills-building trainings or courses which are available at your host institution (freshman seminars, computer training, time management, test preparation skills, research and writing skills, etc.) Please note whether the course listed is a formal course or through an academic support office. Please note number of hours/credits as relevant. If applying for the Global UGRAD-Pakistan program, would you prefer students participate in an academic skills building training series/course or the Critical Study Skills Mentor Program? Academic Skills Building Course/Training series Critical Study Skills Mentor Program If you selected the Critical Study Skills Program, please describe how your institution can facilitate identifying a student mentor to provide 12 hours of mentoring in critical study skills to the student(s). CULTURAL AND COMMUNITY SUPPORT Please indicate below the topics that you will cover in your international student orientation. Cultural Integration Culture Shock Improving English How to join clubs/get involved on campus Campus Resources Other (please describe briefly) 4 P age
What kinds of community service opportunities are available at or near your institution? What kinds of internship options are available at or near your institution? Which fields of study have the most internship options available in your community? What kinds of cultural opportunities are available for students on your campus or in the local community? Please provide a link to all student groups on campus. Please list special cultural and community student support services are available on your campus (ex., volunteer center, career center which supports internship searches, student counseling center, international student club, etc.), including appropriate program website links, if applicable. IREX anticipates that some UGRAD students will be practicing Muslims. Is there a mosque conveniently located near your campus? If not, what arrangements can be made for students religious practices? Does your campus have a Muslim Students Association? Please briefly describe any additional personalized services provided by the international student office at your institution not already described above. 5 P age
LOGISTICAL SUPPORT HEALTH What immunizations and/or medical requirements are needed prior to enrollment? MMR Meningitis Polio Vaccine Diphtheria/Tetanus Tuberculosis skin test and/or chest x-ray Other: ACCESSABILITY : Please check if your on-campus facilities cater to students with special needs, including appropriate program website links, if applicable: Hearing Impaired: Visually Impaired: Physically Impaired: Other: HOUSING and TRANSPORTATION Airports Nearest Commercial Airport and Distance from Host Institution: Second closest option (if applicable): Housing What type of on campus housing is available to international students? (Select all those that apply) Please note all UGRAD Students must have an American roommate. Dormitory (single occupancy) Dormitory (double occupancy) Dormitory (triple occupancy) Other (please describe briefly) Suites Apartments Host Family Do you have single-gender housing available on campus? Yes, rooms on single-gender floors are available Yes, rooms in single-gender dormitories are available No 6 P age
Do you have substance-free housing available on campus? Yes, rooms on substance-free floors are available Yes, rooms in substance-free dormitories are available No Meal Plans Is a meal plan offered? Yes No If No: Please indicate meal options for international students: Cooking facilities in residence On campus establishments Local establishments Other: Estimated monthly amount needed for meals: If Yes: Please choose the option that best reflects your institution s full-meal plan: 15 meals per week 19 meals per week 21 meals per week Other: Type of meal plan offered: Flat fee (all you can eat) Reducing meal account or meal card Other: Please indicate the dates the meal plan is effective during the 2014-2015 academic year: Fall: Spring: Do you have vegetarian options available in your dining hall? Yes No Do you have Halal options available in your dining hall? Yes No Briefly describe how students can meet Halal requirements eating on campus and/or in the community (Halal offering, vegetarian offerings, Halal restaurants, Halal grocery stores, etc.): 7 P age
Temporary Housing It may be necessary for students to arrive prior to the when housing opens or remain on campus during school breaks. IREX requests that all host institutions assist in temporary housing arrangements for students if campus housing is not available. Please list the best temporary housing option for international students (i.e. host family, dormitory, hotel): Temporary Housing Option: Housing cost per day: Meal cost per day (if meal plan is not available): If the student decides not to travel during academic breaks (winter break, spring break, etc.), will on-campus housing be available? Yes No Transportation Describe the transportation options available to students on campus and in the community: Shuttle to and from campus (check student access): daily weekdays only weekends Bus and/or metro rail (check student access): daily weekdays only weekends Walking/biking distance to school and community Other: 8 P age
FINANCIAL SUPPORT Please carefully complete the table on the next page with the following considerations: Costs should reflect one academic year, divided by each semester Indicate the amount of cost-share in dollars per semester, rather than percentage or number of credits that your institution is able to provide for each student you wish to host. Also, please state the expected cost for IREX per student hosted per semester as well as a total sum of these figures. Include all expected fees that a student will encounter, including but not limited to activity and library fees. Include all deposits which must be made for the student to secure admission, enrollment, housing, meals, etc. Do not include the costs of books and other educational materials, as all students are provided with a book allowance. Costs should reflect a full-time student course load Please include health insurance costs if you are applying for the Global UGRAD- Pakistan program or the Kosovo UGRAD program, or your school requires that UGRAD students purchase the institution s health plan in addition to the program health plan. o Students participating in the Global UGRAD in Eurasia and Central Asia program and Tunisia UGRAD program are provided with the Accident and S ickness Program for Exchanges (ASPE) coverage as required for J-1 visa exchange visitors from the Bureau of Educational and Cultural Affairs of the US Department of State. If you have any questions about the terms of coverage provided by this program, please contact IREX or visit http://usdos.sevencorners.com/. Under Other Fees, please include any additional expenses your institution is able to cost share, and list below (ie: transportation, partial books, health insurance, waived fees etc.) IREX will not be held financially accountable for expenses not included on this form. Increases in costs, which may occur after submission of this application, must be reported directly to IREX for consideration and included in the final third party billing agreement between IREX and the host institution during the late spring of 2014. Selection of host institutions and pl acement of students is contingent upon the availability of U.S. Government funding and approval and receipt of J-1 visa by program participants. 9 P age
Costs for One Semester Costs for Academic Year 1 2 3 4 5 6 7 Semester Semester Total Semester Academic Year Academic Cost Share Cost for Cost for UGRAD Cost Share Year Cost provided by IREX Student provided by for IREX Host Column 2 + Column 3 Host 2014-2015 Host Institution Costs Full-Time Tuition Costs Housing Board (Full Meal Plan) (If meal plan is not available, please list the suggested amount students should receive for monthly grocery allowance) Deposits (housing deposits, admissions deposits, etc. which must be paid once for each new student) Mandatory Fees Orientation Fees Application Fees Health Insurance** (if applicable) Other Fees:*** Total Academic Year Cost for UGRAD Student Column 5 + Column 6 TOTAL ** Students participating in the Global UGRAD in Eurasia and Central Asia program and Tunisia UGRAD program are provided with the Accident and Sickness Program for Exchanges (ASPE) coverage as required for J-1 visa exchange visitors from the State Department: http://usdos.sevencorners.com/. If you are applying for the Global UGRAD-Pakistan program or Kosovo UGRAD program, or your school requires that UGRAD students purchase the institution s health plan in addition to the program health plan, please include health insurance costs above. ***Under Other Fees, please include any additional expenses your institution is able to cost share, and list below: (ie; transportation, partial books, etc.) 10 P age
If you are applying for the Global UGRAD-Pakistan program or Kosovo UGRAD program, or your school requires that UGRAD students purchase the institution s health plan in addition to the program health plan, please indicate the procedures for arranging this coverage: What is the maximum number of credits/hours students can take per semester/quarter under this financial statement? Please indicate the number of credits that constitute full-time study per term/semester: The submission of this application and c osts represent a c ommitment on t he part of the institution to provide the level of support shown. Institutions must indicate if cost-share has been requested but is not yet available. Institutions must also indicate if a general tuition increase is expected and an estimate of this increase. Please specify any terms and the date on which financial arrangements will be confirmed. I understand the information provided by my institution in this application and, if selected to host, agree to provide the services and support requested in the application instructions and indicated in our proposal 2. I understand that the selection of host institutions and placement of students is contingent upon the availability of U.S. Government funding and approval and receipt of J-1visa by program participants. Submitted by: Name of Authorized Institution Representative (print) Signature of Authorized Institution Representative 3 Date 2 In addition to submitting this completed application, please include the CV of the host institution s proposed host advisor and the 2014-2015 Academic Year Calendar. 3 Application must be physically or electronically signed by an authorized institution representative. A scanned copy of the signed signature page is sufficient to meet this requirement. By typing your name in the signature line, you are agreeing that you understand the information provided in this application and to provide the services and support requested in the application instructions and indicated in your host institution s proposal. 11 Page