University of Pittsburgh Office of Undergraduate Research, Scholarship, and Creative Activity Dietrich School of Arts & Sciences This Agreement is the legally binding document that will guide you and inform you of the terms, policies and procedures regarding your upcoming international experience, made by you to the University of Pittsburgh Of the Commonwealth System of Higher Education (herein the "University"). This Agreement contains a release of rights. Read carefully before signing. In consideration for being permitted to participate in my international education opportunity under University of Pittsburgh auspices, I hereby agree and represent that: I. Academic Credit: I understand that if I am to receive academic credit for my international experience, it is my responsibility to ensure that such credit is approved via the dean s office or academic advisor in my home school and/or department. I will register for any credit directly with my home school and/or department and will be billed according to its standard billing practices. II. III. IV. Academic Internships, Medical Rotation, or Independent Research: I understand that if I am planning to participate on an academic internship, medical rotation, or independent research for my international experience, it is my responsibility to ensure that I abide by any associated terms and conditions. Academic Funding: I understand that if I am receiving funding for my international experience, it is my responsibility to ensure that I abide by any terms and conditions associated with that funding. Standards of Conduct: I acknowledge the following policies and procedures relative to behavioral matters: A. Conduct While Abroad: I understand that studying abroad is a privilege. While I am participating on my study abroad program, I realize that I am a guest of the host country. As such, there are certain behaviors which may be considered inappropriate and/or unacceptable and could lead to disruption of the program. I understand that clothing and behaviors that are acceptable in the United States may not be considered appropriate in my host country. I hereby assure the University that I shall conduct myself in an appropriate manner which does not infringe upon the laws, customs, and mores of the country or countries in which the program is conducted, nor upon the rights, health, and safety of myself or of other program participants (which includes students, instructors, staff, and members of the local community). Behavioral responsibilities shall be applicable during the course of the program both when I am in the company of other program participants and when I am physically separated from other program participants. In addition, I understand that as a registered University of Pittsburgh student while abroad, I must adhere to all policies outlined in the University of Pittsburgh Student Code of Conduct and Judicial Page 1 of 6
Procedures and all rules and policies established for the program in which I am participating. Misconduct of any sort may be cause for in-country legal prosecution, institutional reprimand, referral to counseling if such services are reasonably available, involuntary withdrawal from the program (Section III.D.), and action under the University of Pittsburgh Student International Code of Conduct and Judicial Procedures upon return to the University of Pittsburgh. If involved in alleged civil or criminal misconduct abroad, I am responsible for all costs, expenses, fees, and fines associated with any civil or criminal actions or penalties and for retaining my own counsel at my own expense. I also understand that per federal and international law and treaties, the University of Pittsburgh cannot intercede on my behalf should I be arrested and/or detained for any reason in a foreign country. I understand that the University reserves the right, at its sole discretion, to decline to award credit to any participant should such participant s behavior jeopardize the success of the program, the experience of other participants, or the health, safety, and general welfare of the person or the other participants. B. Drugs, Alcohol, and Related Misconduct: I understand that I am subject to all alcohol and drugrelated laws of the host country, which may differ considerably and whose penalties may vary greatly in length and severity from those in the United States. Accordingly, I understand that it is my responsibility to determine what constitutes an illegal drug in any country where I will be studying or traveling. I understand that the use, possession, purchase, or sale of illegal drugs during the program or being knowingly present in instances of use, possession, purchase, or sale of illegal drugs during the program may be cause for involuntary withdrawal from the program. Furthermore, I understand that any inappropriate behavior due to the abuse of prescription drugs and drugs considered legal in the host country will not be tolerated and may be cause for involuntary withdrawal from the program. I understand that cultural mores regarding the consumption of alcohol vary widely across cultures. I will respect both the laws and cultural mores in my host country regarding alcohol consumption. Any alcohol abuse and related misconduct will not be tolerated and may be cause for involuntary withdrawal from the program at the sole discretion of University of Pittsburgh officials. C. Involuntary Withdrawal: Should I be involuntarily withdrawn from my program, I acknowledge that all expenses and logistical arrangements associated with my mandatory egress from the host country shall be my exclusive responsibility. Additionally, I understand that I am still fully responsible for any program-related expenses which I have already paid or have yet to pay. Finally, I understand that involuntary withdrawal from the program may result in the denial of credit (if applicable). V. Health, Safety, and Security Responsibilities: I acknowledge that there are certain risks inherent in international travel and that immediate medical assistance may not be available. I likewise acknowledge that I am solely responsible for my safety while participating on my program and while engaged in independent travel during my program dates. A. Pre-program Preparation: I acknowledge that I have been advised to consult with a medical doctor with regard to my personal medical needs (including mental health issues, allergies, dietary restrictions and preferences) and there are no health-related reasons or problems which preclude my Page 2 of 6
participation in the program. I will also receive vaccinations and prophylaxis in accordance with the Centers for Disease Control (CDC) recommendations and requirements of my host country prior to travel and documentation of such (http://wwwnc.cdc.gov/travel/). I will work with my medical doctor or travel medicine specialist to create a plan for how to treat any existing chronic medical issues while I am abroad, and will share this information with the University upon the University s request. Where significant health issues exist or when such arise, I agree to provide the University information about my health condition upon request, such as a medical certification, and to engage in an interactive process, so that the University may determine whether I am medically able to participate in the program. Additionally, if I am taking any prescription medication, I will obtain a sufficient supply for the entire duration of my program prior to the start of my program. I understand that my host country s laws determining the legality of prescription medication may differ from those in the United States and it is my responsibility to determine how to follow these laws. I also understand that it is generally illegal to ship prescription medication through the mail (or International Educational private carriers, i.e. FedEx, UPS, etc.) and it is also generally illegal to have another person carry/import prescription medications across international borders on my behalf. Please note: replacing prescription medication abroad is not advisable unless absolutely necessary, as compounds may vary slightly but enough to cause an adverse reaction to the medication itself. Orientation: I acknowledge I have been informed to read the associated Pre-Departure pages which are available on the Study Abroad Office website (http://abroad.pitt.edu/safetyfirst). I also acknowledge that I have read and understand any advisories, warnings, provisions, and countryspecific information listed on the Department of State s website: www.travel.state.gov/travel/travel_1744.html. I agree that I am also responsible for reviewing all such advisories, warnings, provisions, and country-specific information again shortly before my departure. I further agree to adhere to the University of Pittsburgh s Guidelines Concerning Study and Research in Countries Under State Department Travel Warnings published in the Health, Safety, and Security pages of its website (www.abroad.pitt.edu). Health Insurance: I understand that I am required to maintain health, accident, and hospitalization insurance sufficient to cover medical contingencies while participating in the program. I understand that the University will provide me with insurance coverage via an international insurance provider during the dates of my program. I understand I am responsible for understanding the scope of the insurance coverage provided to me through the University. I also understand that certain activities may be excluded from coverage. My signature below indicates that I understand the scope of the insurance coverage and exclusions from insurance coverage that is provided to me through the University. By my signature below, I release the University, its Trustees, officers, employees and agents from any liability or expenses for my injuries or illnesses (including death) or the need for evacuation or repatriation occurring during and/or arising from the program. Page 3 of 6
Medical Care and Hospitalization: The University of Pittsburgh does not assume responsibility for the provision of medical services to me or the payments thereof while I am participating on my study abroad program. Further, I am aware that the University cannot be responsible for attending to any of my medical needs. I am aware that, should I require hospitalization while in a foreign country or in the United States during the program, the University cannot and does not assume legal responsibility for payment of such costs; rather, I hereby assure the University that I have assumed all risk and responsibility and that I have adequate funds to meet any and all ancillary medical costs during the course of the study abroad program, e.g. copays, prescription costs, over the counter medications, transport to/from a hospital or clinic. I acknowledge that on rare occasions an emergency may develop in which I would require the administration of medical care, hospitalization, or surgery. Therefore, in the event of injury or illness necessitating emergency medical care, I hereby authorize the University of Pittsburgh and its authorized representative(s) or agent(s) in charge of the study abroad program, to secure any necessary treatment deemed appropriate, including the administration of anesthetics and/or surgery on my behalf. I also acknowledge that medical care abroad may vary in quality and availability from medical care and services in the United States, and that I have read and understand the RELEASE in Section VII.B of this agreement. Students with Disabilities: I acknowledge that the absence of law mandating equal access for individuals with disabilities in some countries may affect the ability to provide accommodations in certain locations. Disclosure of the disability to the University of Pittsburgh Disability Resources and Services will ensure that efforts are made to prepare me for limitations to access in certain locations. I understand that accommodations will not be provided unless I am registered with Disability Resources and Services and provide sufficient notice. VI. VII. Program cancellation and withdrawal: I understand that the University of Pittsburgh reserves the right to withhold academic credit for the program and/or require me to leave the program before the end of the term. For example, the University of Pittsburgh may require my departure due to misconduct, an issued travel warning or health or safety emergency. I recognize that if the University decides to withhold credit or requires me to leave the program before the end of the term or if I decide to return before the end of the program, there is no guarantee that I will receive any credit or a refund of tuition or any other fees paid for the program. In no event will the University of Pittsburgh reimburse students for cancelled or changed transportation, related fees, or penalties, if the reason for the cancellation is one out of the University of Pittsburgh s control, e.g. natural disaster, political unrest, health or safety emergency, acts or threats or violence against Americans or terrorism. Indemnification and Release from Liability A. Indemnification: I shall indemnify and hold harmless the University of Pittsburgh, its officers, trustees, employees, agents and representatives from any and all claims, demands, liabilities, costs, Page 4 of 6
and causes of action and all expenses incidental thereto (including reasonable attorney's fees), based upon or arising out of any personal injury (including death), property damage or loss caused by or resulting from my acts or omissions during my time overseas. B. Release from Liability: I UNDERSTAND THAT THERE ARE SIGNIFICANT RISKS WHICH ARE INHERENT IN INTERNATIONAL TRAVEL AND WHICH MAY CAUSE SERIOUS BODILY INJURY, DEATH AND /OR PROPERTY DAMAGE, INCLUDING BUT NOT LIMITED TO RISKS ASSOCIATED WITH AIR TRAVEL, HAZARDOUS ROAD CONDITIONS AND GROUND TRAVEL, STREET CRIME AND VIOLENT CRIME, DISEASE, TERRORISM, CIVIL UNREST, AND VARYING DEGREES OF MEDICAL CARE. I UNDERSTAND THAT I AM SOLELY RESPONSIBLE FOR MY SAFETY AND ASSUME RESPONSIBILITY FOR ALL RISKS ASSOCIATED WITH PARTICIPATION IN THE STUDY ABROAD PROGRAM. I RELEASE, HOLD HARMLESS AND PROMISE NOT TO SUE THE UNIVERSITY, ITS TRUSTEES, OFFICERS, EMPLOYEES AND AGENTS FOR ANY AND ALL LIABILITY, CLAIMS, COSTS AND ACTIONS THAT MAY ARISE FROM INJURY OR HARM TO ME (INCLUDING DEATH) OR FROM DAMAGE OR LOSS TO PROPERTY IN CONNECTION WITH MY PARTICIPATION IN THE PROGRAM. I UNDERSTAND THAT THIS WAIVER AND RELEASE COVERS LIABILITY, CLAIMS, COSTS OR ACTIONS CAUSED ENTIRELY OR IN PART BY ANY ACTS OR FAILURE TO ACT OF THE UNIVERSITY (OR ITS TRUSTEES, EMPLOYEES OR AGENTS), INCLUDING BUT NOT LIMITED TO NEGLIGENCE, MISTAKE OR FAILURE TO SUPERVISE BY THE UNIVERSITY. I RECOGNIZE THAT THIS WAIVER AND RELEASE MEANS I AM GIVING UP, AMONG OTHER THINGS, RIGHTS TO SUE THE UNIVERSITY FOR INJURIES, DAMAGES, OR LOSSES I MAY INCUR. I ALSO UNDERSTAND THAT THIS WAIVER AND RELEASE BINDS MY HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNS, AS WELL AS MYSELF. VIII. Miscellaneous Provisions A. Governing Law: This Agreement shall be governed by the laws of the Commonwealth of Pennsylvania, without regard to conflicts of law principles, and any dispute relating to this Agreement that is unable to be informally resolved by the parties shall be heard in state or federal court in Allegheny County, Pennsylvania, to which parties consent to personal jurisdiction. Modification: This Agreement represents the entire understanding of the parties with regard to the subject matter, and may not be modified, assigned, or amended except by a signed written agreement of the parties. B. Family Educational Rights and Privacy Act (FERPA) Waiver to Release Educational and Other Records: I authorize the University of Pittsburgh to release to my parent(s) or legal Page 5 of 6
guardian(s), program administrators, and representatives of third party program providers my educational and other records, including but not limited to my contact information, health information, academic record, financial information, and general information related to the program at the University s discretion. I understand the purpose of this release is to provide academic, health, welfare, safety and other information to my parent(s) / legal guardians, and also to provide representatives of third party providers and program representatives such relevant information so they may make academic, health, safety and other decisions and appropriately administer the program. C. Savings Clause: I agree that, should any provision or aspect of this agreement be found to be unenforceable, all remaining provisions of this agreement will remain in full force and effect. D. Photo Release: I authorize the University of Pittsburgh to use statements made by me or photographs and video footage of me for publicity and advertising purposes. E. Integration Clause: This agreement represents my complete understanding with the University. It supersedes any previous or contemporaneous understandings and cannot be changed or amended in any way except in writing. I am signing this agreement knowingly and voluntarily. I understand its contents and have had a reasonable opportunity to consult with an attorney about its terms and conditions. If I do not desire to sign this agreement, I understand that I may not register through the University of Pittsburgh, but may enroll directly with a foreign university or study abroad program. In the event that I directly enroll elsewhere, credit transfer and the use of scholarships and financial aid emanating from the University of Pittsburgh is not guaranteed. INTENDING TO BE LEGALLY BOUND, I have knowingly, voluntarily and willingly executed this Agreement this of, (Day) (Month) (Year) (Signature) Page 6 of 6