Study Abroad Registration Instructions

Study Abroad Registration Instructions We commend you for wanting to enrich your life with a study abroad experience. 1. READ INSTRUCTIONS PRIOR TO BEGINNING THIS PROCESS 2. SAVE THIS DOCUMENT ON YOUR COMPUTER AS "FIRST NAME LAST NAME LOCATION AND SUBJECT" PRIOR TO FILLING IT OUT. IE. Jane Doe Rome ENGL If you don't have a computer, please save it on a flash drive. 3. NOW, fill out the application and hit SAVE again. 4. Pay your deposit into the correct semester.(ie Rome FYE is Spring 2018) You pay your deposit on-line as you normally make payments. You can do so in the business office and they will be glad to help walk you through. We accept credit cards, checks and cash. If you pay cash, please ask the business office to email the receipt to you. 5. Save your receipt First Name, Last Name Location and Subject IE. Jane Doe Rome ENGL. 6. PRINT and TAKE the first page to Student Affairs for approval. (They are located on the 2nd floor in Crooker above the Cafeteria dining area. They will forward the form to the Study Abroad office.) DO NOT SIGN THIS PAGE 7. Email the following to studyabroad@stthom.edu (with Subject Line First Name, Last Name Location and Subject IE. Jane Doe Rome ENGL.) A. Completed application B. Deposit Receipt C. Copy of Passport (Must be valid for 6 months after return date) D. Copy of Visa or Green Card (if applicable) - All VISA holders are required to check in with the International Student office. i. If you hold a VISA and you are required to attain a VISA to travel to your destination location, it is the responsibility of the student to attain that VISA unless a VISA is required of all travelers such as China 8. PRINT and SIGN (Under 21? Parents must sign) the Signature Page Bring your signature page to the Study Abroad office located in Tiller Hall at 4121 Yoakum. 9. If your destination course registration is in Fall or Spring Terms, you will make payment arrangements with the Business office or it will automatically change your payment amount on your Nelnet plan. Please contact the business office for further instructions on Fall and Spring course payments. 10. If your destination course registration is Summer I or Summer II, you will need to make payment arrangements with Study abroad office. The full amount must be paid in full by March 31,2018 The study abroad office will be glad to answer any questions you might have. studyabroad@stthom.edu 713-525-3530

PROGRAM LOCATION: Dates Course: Address: City: State: Zip: E-Mail Address: Cell Phone: The above student has been cleared to study abroad by the Office of Student Affairs _ Print Name Signature Date STUDENT AFFAIRS SIGNATURE ONLY

PROGRAM LOCATION: PART A- REGISTRATION INFORMATION Address: City: State: Zip: E-Mail Address: Cell Phone: ( ) - Addl. Phone Number: (713, 281, 832 or ) - Frequent Flier #: Classification: Freshman (0-30) Sophomore (31-60) Junior (61-90) Senior (90+) Senior 5 Graduate Marital Status: Single Married Other Enrollment Status: Full-time Part-time Major: _ Gender: Male Female If graduate student: MLA MBA, Concentration: Age at time of travel: Date of Birth: City of Birth: mm/dd/yyyy Program Cost: $ Cost Includes: Airfare, housing and breakfast, Ground Transportation, Excursion & Insurance. Tuition not included in program cost All flight deviation requests must be made in writing via your UST email address to speaksd@stthom.edu within 14 calendar days of your application. The request must include return date request, amount you are willing to pay for deviation. The flight change will include flight change fee and flight fare difference. I understand this requirement. Please sign here. type in initials here and sign #1 on last page Please list the course(s) you will be taking: 1. 2. I understand that Winter programs are to be paid with Fall tuition, Spring CTB courses and program cost are to be paid with Spring tuition, Summer I and II payments must be made prior to March 31. Payments must be made on my school account in the Business Office. A copy of my payment must be provided to the Study Abroad office in Tiller Hall. I understand that no refunds will be given after normal drop dates for CTB courses or February 12 for Summer I and II programs. Signature (STUDENT OR, IF UNDER 21, PARENT/GUARDIAN)type in initials here and sign #2 on last page For office use only:

Are you of Hispanic, Latino, or Spanish descent? No Yes, Mexican, Mexican American, Chicano Yes, Puerto Rican Yes, Cuban Yes, other: Race; select all that apply: White Black, African American American Indian or Alaska Native Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Pacific islander, please specify Other race Are you an international student? No Yes If yes: I hold an F visa I hold a J visa I hold an M visa Primary source of funds for study abroad: Personal and family University scholarship Foreign government US government US private sponsor Foreign private sponsor International organization Current employment List any UST Scholarships: Will you be applying for Financial Aid? (Please note that you must pay for your program prior to departure and it is the responsibility of the student to sign proper forms at the financial aid office when using a scholarship for partial payment of study abroad program. Financial aid posts to the student account during or after the study abroad program and credit should be refunded then

PASSPORT INFORMATION: First Name: Middle Name: Last Name: Passport Number: GREEN CARD/US VISA (If applicable): Issuing country Exp Date: mm/dd/yyyy First Name: Type of Document: Issuing Country: Green Card Visa Last Name: Exp Date: mm/dd/yyyy Page 1 of 1

PART B- EMERGENCY MEDICAL CARE AUTHORIZATION In the event of a medical emergency, the University of St. Thomas will make every effort to reach the person designated as an emergency contact before using the authorization below. In case we are unable to communicate with the emergency contact person immediately, your signature on this optional authorization may assist in obtaining necessary medical care. Choose either A or B: A) To prevent dangerous delay in the event of an extreme emergency requiring hospitalization and/or surgery. I hereby authorize the resident faculty, or appropriate authority, of the University of St. Thomas Study Abroad program to secure whatever treatment is deemed necessary for me/my child including the administration of an anesthetic and/or surgery. Signature (STUDENT OR, IF UNDER 21, PARENT/GUARDIAN) type in initials here and sign #3 on last page B) I do not authorize the University of St. Thomas to secure medical treatment on my/ my child s behalf. Signature (STUDENT OR, IF UNDER 21, PARENT/GUARDIAN) type in initials here and sign #3 on last page INSTRUCTIONS SPECIFIC TO MY MEDICAL STATUS Do you have any medical conditions? Yes No If Yes: Medical condition(s): Symptoms that may indicate unstable medical status: Best method of assistance: Current medications: Known allergies and other instruction: Treating physician s name and phone#: Medical insurance provider and number:

EMERGENCY CONTACT INFORMATION: Contact 1: Name Relationship to you Primary Number: Secondary Number: Other: Address: City: State: Zip: Contact 2: Name Relationship to you Primary Number: Secondary Number: Other: Address: City: State: Zip: PART C- INSURANCE INFORMATION All students in the UST group programs will be insured by Lewer Agency. If you have additional insurance that is valid for their participation in the above-mentioned program, please provide your insurance coverage information. I do not have other insurance. Insurance Carrier (Company): Policy #: Group #: Subscriber s Name: Subscriber s Phone #: Relationship to you: Subscriber s Address: City: State: Zip: All students and parent/guardian (if applicable) must sign the statement below: I certify that I/my child will maintain adequate medical insurance coverage from the start of the program through the end of the academic enrollment period. If this coverage is not through the University of St. Thomas, I certify that I/my child will maintain enrollment in the above medical insurance plan for the duration of the program. I understand that the University of St. Thomas Study Abroad Office is not responsible for my/my child s medical expenses. I acknowledge that I am legally responsible for all medical and insurance expenses incurred by myself/my child. I certify that this information is true and accurate. Signature (STUDENT OR, IF UNDER 21, PARENT/GUARDIAN) type in initials here and sign #4 on last page NOTE: If you have insurance other than the University of St. Thomas medical insurance through The Lewer Agency, be sure to bring claim forms for your insurance carrier with you abroad.

PART D- TERMS AND CONDITIONS As a participant, I agree that I will: 1. Review all materials and information pertaining to study abroad prior to participation 2. Assume responsibility for my own personal preparation for the activity 3. Obtain and maintain appropriate insurance coverage 4. Understand and comply with these terms of participation and emergency procedures 5. Understand and comply with all UST Codes of Student Conduct 6. Obey the law 7. Conduct myself in a manner that is respectful of others 8. Accept responsibility for my own decisions and actions 9. Keep the trip coordinator informed of my needs Please read and initial the following: I have read and understand the University of St Thomas Study Abroad Handbook and agree to abide by the policies and conditions therein. I understand that if I choose to cancel, any monies paid to the program are non-refundable. I understand that if I choose to cancel, I may be charged for expenses incurred on my behalf in addition to the non-refundable deposit (Page 1). I have read and understand The Acceptance Statement and Student Declaration for the UST Study Abroad Program (Hand Book Page 16). I have read and understand the Technical Standards for the UST Study Abroad Program and I am able to meet these standards (Hand Book Page 17-18). I have read and understand the Study Abroad Agreement, Release and Participant Agreement form (Hand Book Page 19-20). I have read and understand the study abroad accommodations and disability services for students (Hand Book Page 21) I have read and understand the release waiver and indemnity form (Hand Book Page 21). I UNDERSTAND I CAN PURCHASE TRAVEL INSURANCE W/N 14 DAYS OF STUDY ABROAD DEPOSIT PAYMENT Initial: Initial: Initial: Initial: Initial: Initial: Initial: Initial: Initial I understand the requirements and agree to abide by study abroad and UST regulations. type in initials here and sign #5 on last page Signature (STUDENT OR, IF UNDER 21, PARENT/GUARDIAN)

APPLICATION PROCEDURE AND CHECKLIST Provide cover page to student affairs for approval. (2 nd floor in Crooker above dining hall). They will forward to the study abroad office. Complete this application form online in its entirety Print and sign where indicated Attach two official PASSPORT SIZE head shots. (Only if VISA is required for the whole program such as China) Attach a copy of the information page of your passport (the page with your picture) and VISA if applicable. If you do not yet have a passport, please apply for one immediately and mail/drop off a copy of the information page once you have received your passport. Proof of application for a passport is required upon submission of this packet (i.e. receipt.) Make a copy of this packet for your records. TRAVEL INSURANCE IS AN ADDITIONAL OPTION WHICH I CAN PURCHASE DIRECTLY FROM THE TRAVEL AGENT at www.futuretr.com/travel-insurance or I can contact Michelle Weller directly via email at ust@travelleaders.com to purchase. To cover pre-existing conditions, I understand I must purchase within 14 days of my deposit payment/registration with the study abroad office. The travel agent will confirm my deposit payment date with the study abroad office. Please sign here to acknowledge you have been informed of this option. type in initials here and sign #6 on last page (STUDENT OR, IF UNDER 21, PARENT/GUARDIAN)

Signature sheet 1. I understand the full amount of the program and any flight deviations must be requested within 2 weeks of submission of this application. 2. I understand payment deadlines of Nov 30 for Winter programs and March 31 for Summer programs. 3. I (do) (do not) authorize the University of St. Thomas to secure medical treatment on my/ my child s behalf. 4. I certify that I/my child will maintain adequate medical insurance coverage from the start of the program through the end of the academic enrollment period. And I acknowledge that I am legally responsible for all medical and insurance expenses incurred by myself/my child. If this coverage is not through the University of St. Thomas, I certify that I/my child will maintain enrollment in the above medical insurance plan for the duration of the program. 5. I understand the requirements and agree to abide by study abroad and UST regulations. 6. I understand that travel insurance is an additional option which I can purchase directly from the travel agent.