Application Form. General Information

Transcription

1 Application Form Please complete the form below. Ensure the information provided matches the information on the passport you will be travelling with. In addition to this form, you are required to submit a signed UTM Abroad Medical Form and $250 first installment by the application deadline in order for your application to be considered complete. The information on this form is collected in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA) for the selection and logistical planning of the UTM Abroad Courses and Co-Curricular Experiences. All applicants must be in good academic standing (minimum 1.5 CGPA). Applications will be considered on a first-come, first-served basis. Note: Select courses and co-curricular experiences may include an interview process for candidate selection. General Information First Name (as shown on passport): Middle Name (as shown on passport): Last Name (as shown on passport): Student Number: Program Choice: Which experiences are you interested in? (Check all that apply) Mexico ENV431 & SSM2050 Environmental Sustainability Cambodia SOC485H5F Investigation through Study Abroad: Contemporary Cambodian Politics and Society Tanzania - ANT335H5F Anthropology of Gender Chile - WGS420HS Engendering Human Rights

2 France and England - FAH287H5S European Art of the Nineteenth Century Italian - ITA235H5S Cucina Italiana: Italian History and Culture Through Food Bahamas - UTM290H5S utmone Scholars: Launching Your Research Ranking: If you selected more than one experience, please rank your choices in order of preference. We will use this section to offer alternatives should we not be able to accommodate your first preference. If you are only interested in one trip, please include only your first preference. Preference 1 Preference 2 Preference 3 Address (Please use your official utoronto address): Gender: *Please note that most trips include shared gender accommodations (e.g. participants sharing mixed gender accommodations at a hostel/hotel). Please contact us should you want more details or would like to discuss the arrangements. Date of Birth (DD/MM/YYYY): Phone Number: Do you speak any languages other than English? Yes No If yes, please indicate your level of fluency (basic, moderate or fluent) for each language: Language: Language: Language: Level of fluency: Level of fluency: Level of fluency: Passport Information For the information below, please ensure that you are using the details of the passport you will be travelling with. Passport Country of Issue:

3 Passport Number: Passport Expiry Date (DD/MM/YYYY): Fitness Level Please include detail your fitness level below. To assess the fitness level required for each experience, please refer to the individual pages of the experiences you are interested in. Fitness level (scale of 1 to 5) Not active Barely active Somewhat active Moderately active Very active (would have no problem hiking up a mountain) Please provide examples of how you keep fit in everyday life: Thinking Ahead Why would you like to participate in the experiences you have selected?

4 Why should you be selected to participate in this experience? What do you expect to get out of this experience? Please tell us how you feel about the following program elements. 5 means most excited and 0 means not excited at all. Finding yourself off the grid in a secluded rarely traveled to place:

5 Single and/or multi day treks: Thinking critically about regional and global issues: Trying new and unfamiliar foods: Sleeping according to local standards (bamboo mats, hammocks, hostel beds, etc.): Having infrequent access to electricity, air conditioning, and running water: Spontaneous, ever adaptive itinerary: Emergency Contact Information Emergency Contact First Name: Emergency Contact Last Name: Emergency Contact Phone Number: Emergency Contact Alternate Phone Number: Emergency Contact Relationship to you: Terms of Participation Participants must complete the required application by the specified deadline as found on Participants must accurately complete and submit the UTM Abroad medical form by the specified application deadline. When required, the participant must submit an additional medical clearance form signed by a physician;

6 Fees Participants must meet all outlined payment deadlines and participate in all the required sessions/events leading up to the international experience as well as reintegration and reflection events or activities held after the experience. This may include training sessions, community events, predeparture orientations, etc.; Participants will continue to adhere to the University of Toronto policies including but not limited to the Code of Student Conduct and the Policy and Procedures: Sexual Harassment;; Participants are required to participate in a Safety Abroad workshop at UTM or at the Centre for International Experience and must register with the Safety Abroad database prior to departure; Participants are responsible for familiarizing themselves and acknowledging the risk of the particular out-of-country activity, taking appropriate precautions as needed. Participants are encouraged to familiarize themselves with and monitor the Government of Canada Travel Advisories as well as refer to the Safety Abroad website for additional details and resources; Participants are responsible for making a self-assessment regarding appropriateness of participation; Participants must connect with the appropriate resource on campus and make any requests for accommodation within 30-days of the application deadline; Participants are responsible for obtaining and providing proof of their travel insurance at least 30-days prior to departure. Participants are responsible for determining the adequacy of their travel insurance and ensuring it meets their medical and experiential needs for the duration of the international experience; Participants are responsible for obtaining appropriate travel documentation (e.g. visitor visas). Refunds will not be awarded for trip cancellations due to delayed visa applications; Participants agree to the sharing of their health and safety information with the University of Toronto staff member supporting the international experience for use in the case of an emergency; Participants agree to the sharing of information between University services for matters related to their health and safety; Participants are responsible for obtaining any required immunizations, seeking medical advice as needed prior to departure and ensuring they have any required medication readily available to them during the international experience. Participants are encouraged to visit the Public Health Agency of Canada website for information regarding travel vaccinations Participants are encouraged to purchase trip cancellation insurance. All applicants are required to submit a $250 non-refundable first installment by the application deadline to be considered for participation in any of the UTM Abroad Courses or Co-Curricular Experiences; All fees must be paid in full by the deadlines outlined on the UTM Abroad website. Failure to meet payment deadlines may result in the cancellation of the applicant's offer of participation in the program with no refund of fees;

7 The fees posted include flights, transportation in-country, meals, accommodation and tours/activities listed in the corresponding itinerary; Fees associated with travel insurance, additional optional tours/activities while abroad, visa applications, medical exams, vaccination and any other additional costs are not included in the program fees; Participants will be held liable for any fees associated with damages caused to the facilities visited or used for accommodation during the international travel experience. Fee Payment Schedule The fee payment schedule for all UTM Abroad Courses can be found under the Payments section. Refund Policy The $250 first installment may only be refunded under the following circumstances: o In the event of a trip cancellation at the University's discretion based on health and safety concerns, insufficient enrollment in the program or any other unforeseen circumstances; o In the event that we are not able to extend an offer of participation due to space limitations or if the applicant is not accepted into the course. All remaining fees are non-refundable. Should the participant face unforeseen circumstances prohibiting them from participating in the program, they should submit an appeal to the International Education Centre detailing their circumstances and providing any relevant documentation. At the discretion of the University and under exceptional circumstances, fees not including the first instalment may be refunded under the following schedule: Description Cancellation prior to the third instalment deadline. Cancellation prior to the fourth instalment deadline. Cancellation after the final instalment deadline and prior to the travel date. Refund Partial refund of the second instalment paid minus a 3% administration fee. The first instalment is not refundable. Partial refund of the second instalment paid minus a 3% administration fee. The first and third instalments are not refundable. Partial refund of the second and fourth and/or fifth instalment paid minus a 3% administration fee. The first and third instalments are not refundable.

8 Signature I have read and understood the above conditions related to participation in the UTM Abroad, and agree to be bound by these terms. Failure to comply may result in my termination from the program. Signature of Student: Print Name: Date: Signature of Witness (Mandatory, not employed by UofT): Print Name: Date: Notice of Collection of Information - Freedom of Information and Privacy Act The University of Toronto respects your privacy. Personal information that you provide to the University is collected pursuant to section 2(14) of the University of Toronto Act, The information is being collected for the purpose of administering admissions, registration, academic programs, university-related student activities, activities of student societies, safety, financial assistance and awards, graduation and university advancement, and reporting to government agencies for statistical purposes. At all times it will be protected in accordance with the Freedom on Information and Protection of Privacy Act. If you have questions, please refer to or contact the University Freedom of Information and Protection of Privacy Coordinator at , Mc Murrich Building, room 201, 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8.