Regent s Park College, Oxford University Tutorial Program Application DEADLINE: 1 February 2016 (for 16/17 Academic Year, Fall 16 or Spring 17 abroad) This form along with all supporting materials and required signatures must be submitted to the Director of International Studies and Enrollment by 5:00 pm on the deadline date listed above. PERSONAL INFORMATION Student Name: ID Number: Cell Phone Number: Mailbox Number: E-Mail Address: Permanent Mailing Address: Skype Username: Age: of Birth: (optional) TERM INFORMATION Intended Year of Academic Study: Term requests: Please rank for first, second and third choice by marking each term with a 1, 2, or 3. Cross out any terms that you cannot go and offer a clear, full explanation below. Michaelmas (October December) Explanation for ruling out terms: Hilary (January March) Trinity (April June) ACADEMIC INFORMATION Current Classification: Freshman Sophomore Junior Senior Current GPA: Academic Major: Academic Minor: Faculty Advisor: GC Tutor: Subject Area of GC Preparatory Tutorial: Office of International Programs: Education Abroad Georgetown College McCandless House, First Floor www.georgetowncollege.edu/international/ea international@georgetowncollege.edu 502.863.8390
TUTORIAL SUBJECT AREA(S)/INTERESTS This section should be completed in consultation with the Director of the Oxford Program. Final tutorial requests will be made at the time of interviews. Tutorial Subject Area: Possible Tutorials: Tutorial Subject Area: Possible Tutorials: PERSONAL STATEMENT In 350 words or less, on a separate sheet of paper, tell why you want to study at Regent s Park College, Oxford. This essay must be typed, double-spaced and error free. REQUIRED CONSULTATIONS AND SIGNAUTRES Director of International Studies and Enrollment Director of the Oxford Program Faculty Advisor STUDENT AGREEMENT: I understand that by signing this application I express my intent to pursue a semester/academic year abroad with the Oxford Program and agree to/understand the following: Submission of this form by the deadline stated above reserves my place for the above indicated term(s) abroad. This form and the above signatures do NOT represent acceptance to the Oxford program or serve as a guarantee to study abroad at Regent s Park College. The study abroad process will require my effort, responsibility, and communication with several campus offices. If my plans change and/or I no longer wish to study abroad via the Oxford Program I must contact the Director of International Studies and Enrollment and the Director of the Oxford Program to cancel/update my application. Failure to communicate such a change in plans may result in my approval to study abroad via the Oxford Program being revoked and/or me being responsible for fees already committed on my behalf. Office of International Programs: Education Abroad Georgetown College McCandless House, First Floor www.georgetowncollege.edu/international/ea international@georgetowncollege.edu 502.863.8390
FEES AND BILLING GUIDELINES Regent s Park requires students to take 12 hours per term. - If a student is registered for one term at Oxford (12 hours) and the combined credit hours for Oxford and any classes taken at GC in that same semester are over 18 hours, the student will be billed at the current rate per credit hour for any hour(s) over 18. - If a student is registered for both Hilary and Trinity terms at Oxford (24 hours) the student will not be billed for additional credit hours unless they exceed 24 hours. A standard GC semester is based on 15 weeks and a 15 meal plan. - If a student stays on campus before/after their time in Oxford and the combined weeks of stay at GC and Oxford is over 15 weeks, that student will be billed for room and board on a pro-rated basis for each week over 15. Students must have an academic purpose to be on campus before/after their time in Oxford. - It is the student s responsibility to communicate with the Office of Student Accounts to insure proper billing for time spent on campus before/after their time at Oxford. I understand and accept this policy. I also agree to pay any fees as described above. Office of International Programs: Education Abroad Georgetown College McCandless House, First Floor www.georgetowncollege.edu/international/ea international@georgetowncollege.edu 502.863.8390
Participation Agreement In order for the Georgetown College Office of International Programs: Education Abroad to consider your application to participate in the Oxford Program, you must read, understand and agree to the following terms and conditions. 1. Fees and Payments: I agree to abide by the conditions and deadlines for payments of Georgetown College tuition and fees related to the Oxford Program as published by the Georgetown College Office of Student Accounts. If I am receiving financial aid and/or a scholarship award for the Oxford Program, I agree to abide by all Georgetown College financial aid deadlines and policies. I understand that failure to comply may result in a financial aid penalty, delay of aid disbursement and could result in my ineligibility to participate in my chosen program. 2. Withdrawal from the Oxford Program: I understand that if I commit to participate in the Oxford Program and then subsequently choose to withdraw, I must contact the Director of International Studies and Enrollment AND the Director of Oxford Programs. Depending upon the timing of my withdrawal, I may be liable for additional program fees already committed on my behalf. 3. Cancellation I acknowledge that it is my responsibility to investigate and understand relevant cancellation policies associated with the Oxford Program. I understand that I must consult with the Director of International Studies and Enrollment AND the Director of Oxford Programs about the financial penalties I will be responsible for paying, should I need to withdraw my application or cancel my participation at any point in time. I understand that should I need to withdraw or cancel my participation in the Oxford Program I must notify the Director of International Studies and Enrollment AND the Director of Oxford Programs. 3. Conduct: I agree to respect and abide by the laws and customs of the host country(s), the host institution(s), the Georgetown College Student Code of Conduct, and any and all other reasonable standards of conduct related to my education abroad program, the Office of International Programs: Education Abroad, its employees, agents, Regent s Park College and other partner institutions and agents abroad. I agree to accept termination of participation in the program abroad with no refund of fees or other costs and no academic credit, and take responsibility for transportation costs home, if my conduct is determined to be detrimental to the best interests of myself, other participants, the program, Georgetown College, or Regent s Park College, such a decision to be made at the sole discretion of the Georgetown College program coordinator and/or Regent s Park College, with the concurrence of the Director of International Studies and Enrollment at Georgetown College, the Director of Oxford Programs and/or other appropriate campus representatives of the Georgetown College Office of International Programs or the Georgetown College Office of the Provost. I acknowledge and agree that I may be required to leave the program at the sole discretion of the College's agents and representatives, and may be referred to the appropriate College Officials for further disciplinary or other action and that, in such circumstances, no refund will be made for my program(s). 4. Health and Safety: I acknowledge that the Office of International Programs: Education Abroad and its agents and partners cannot guarantee the safety of participants or eliminate all risks from the education abroad activities or environments, nor can they monitor or control the daily personal decisions, choices and activities of individual participants, and cannot prevent participants from engaging in illegal, dangerous or unwise activities. I acknowledge that the Office of International Programs: Education Abroad strongly discourages participants from consuming alcohol abroad, even if the drinking age abroad allows such consumption. I acknowledge that the impaired judgment that results from alcohol consumption greatly increases the associated risk of injury and death in unfamiliar environments and unfamiliar cultural settings and that I will be subject to the laws and penalties of my host country for any indiscretions. I have read, understand and agree to the above terms and conditions. Signature Printed Name ID Number Office of International Programs: Education Abroad 400 East College Street Georgetown, Kentucky 40324 USA gogc.me/ea international@georgetowncollege.edu Office Location: McCandless House, First Floor 502.863.8390
Emergency Contact Primary Emergency Contact (REQUIRED) Name: Relationship to You: Home Phone: Cell Phone: E- mail Address: Address: Also a Financial Contact? Yes No If yes, you do not need to repeat this information in the Financial Contact section below. Secondary Emergency Contact (optional) Name: Relationship to You: Home Phone: Cell Phone: E- mail Address: I consent to give the Office of International Programs and other representatives of Georgetown College permission to contact the above named individual(s) in case of an emergency. Financial Contact Name: Relationship to You: Home Phone: Cell Phone: E- mail Address: Address: I consent to give the Georgetown College Offices of International Programs, Student Accounts and Financial Planning permission to contact the above named individual(s) in regards to my financial information as it relates to my education abroad program. Office of International Programs: Education Abroad Georgetown College
FERPA Consent Background: The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level. Students to whom the rights have transferred are "eligible students." When a student turns 18 years of age or attends a postsecondary institution, the student, and not the parent, may access, seek to amend, and consent to disclosures of his or her education records. Once FERPA rights have transferred to a student, Georgetown College employees are limited in what we can discuss with a parent. We cannot disclose any "non-directory" information, that is, any information that would not ordinarily be included in a public directory. Students may make a special request to Georgetown College that even directory information not be disclosed without written consent. If a student is considered a dependent for tax purposes, we may discuss non-directory information with the parent. Otherwise, we must have on file a signed and dated written consent from the student allowing the Office of International Programs: Education Abroad (or other representatives from the Georgetown College Office of International Programs) to reveal the fact that he or she is studying abroad or applying to study abroad and to discuss details of their chosen program and other relevant non-directory information. If a student has listed a parent or other individual as an Education Abroad Emergency Contact, then in situations of health or safety emergencies, we will be allowed to disclose non-directory information to those individuals. Please read the statement below very carefully and sign the agreement below. If you disagree, are unsure or have any questions, please speak with International Programs staff before signing. I consent to give Georgetown College (all offices and employees) permission to reveal that I am studying abroad and/or planning to study abroad, and to discuss details of my chosen program and other related non-directory information, with any individual that I have listed below and anyone whom I have listed as an Education Abroad Emergency Contact or an Education Abroad Financial Contact. This consent is not limited to an emergency situation or to financial information. Signature Printed Name ID Number People with whom my information may be shared in addition to my Emergency and Financial contact(s): Name Name Relationship to You Relationship to You Office of International Programs: Education Abroad 400 East College Street Georgetown, Kentucky 40324 USA gogc.me/ea international@georgetowncollege.edu Office Location: McCandless House, First Floor 502.863.8390
Student Accountability Release of Information I authorize the Georgetown College Office of Student Accountability to release any and all information (including but not limited to dates, incident detail(s) and outcome(s)) pertaining to my judicial record to the Georgetown College Office of International Programs. I understand that this information may be shared as necessary with affiliated study abroad providers and/or programs to which I have formally applied. This release shall be considered expired upon the completion of the study abroad program. Student Printed Name Student ID Oxford Applicants Only: I authorize the Georgetown College Office of International Programs to share the above stated judicial information with the Director of Oxford Programs and with the staff of Regent s Park College, Oxford, United Kingdom as necessary for my participation in the Oxford Program. I also authorize the Georgetown College Office of the Provost to release any and all of the information pertaining to any honor code violations I have been found responsible for to the Georgetown College Office of International Programs and the Director of Oxford Programs. Note: Honor code violations do not necessarily automatically disqualify you from the Oxford application process. This release shall be considered expired upon the completion of the study abroad program. Office of International Programs: Education Abroad 400 East College Street Georgetown, Kentucky 40324 USA gogc.me/ea international@georgetowncollege.edu Office Location: McCandless House, First Floor 502.863.8390