UNCW Office of International Programs  Westside Hall  601 South College Road  Wilmington, North Carolina 28403-5965 Ph: 910-962-3685  Fax: 910-962-4053  [email protected]  www.uncw.edu/international Summer & Short-Term Study Abroad Application Packet Submit completed applications for faculty-led programs to the Program Leader. Submit completed applications for all other programs to the Office of International Programs. Program: Program Leader/Sponsor: Submit completed application (including deposit) by the following deadlines, unless otherwise noted: UNCW faculty-led short-term spring programs: January 8 (unless set earlier by the specific program’s leader) UNCW faculty-led summer programs: March 1(unless set earlier by the specific program’s leader) Affiliated programs (e.g. AIFS, Australearn, CEA, CIEE, ISA, Semester at Sea): March 1 Some programs fill up early so please check with the program leader/sponsor for specific earlier deadline details. Applicant’s Name: ___________________________________ Student ID#_____________________________ Complete the Following Application Materials (Required for all programs by the deadline noted above): _______ Summer & Short-Term Study Abroad Application Form _______ Health Information and Emergency Treatment Form _______ Participant Agreement _______ Two passport-size photos with your name printed on the back _______ Non-refundable Program Deposit: $200 Faculty-led Programs, $100 for Affiliated Programs (payable by check, money order or Visa/MasterCard) Check should be made payable to UNC Wilmington This non-refundable payment covers processing costs and holds your place if you are accepted. Application will not be processed before this payment is received Complete The Following Program Specific Application Materials (If Applicable): _______ Program Specific Application Forms or Requirements (as directed by the Program Leader) _______ Transient Study Form (TSF) (UNCW students only, if applicable) Available at OIP or download at: www.uncw.edu/intprogs/abroad.htm This form is required for any courses you will take during the program but for which you will not directly register at UNCW. _______ Non-UNCW students only: Get admitted as a “visiting students” to UNCW summer school in order to participate on a faculty-led summer study abroad program. The application can be obtained online at: www.uncw.edu/summsch/applytoday.htm (submit this to the program leader, not Admissions) Additional Pre-departure Requirements (Dates and details are noted below or will be provided by your Program Leader/Sponsor) _______ Register for appropriate course(s) at UNCW (if applicable) _______ Obtain a Passport _______ Obtain the appropriate visa (if applicable) _______ Attend pre-departure meeting(s) and orientation(s) International ProgramsUNCW Office of International Programs  Westside Hall  601 South College Road  Wilmington, North Carolina 28403-5965 Ph: 910-962-3685  Fax: 910-962-4053  [email protected]  www.uncw.edu/international International Programs Summer & Short Term Education Abroad Application Program Information Name of Program/Institution: _____________________________ Country:_______________________ Study Period: Summer 20 ____ Spring Break 20____ Other (Please specify) ___________________ Personal Information _________________________________________________ ________________________________________ Last Name First Middle Home Campus ______________________________ ______________________ ___________________________________ Student I.D.# Date of Birth (MM//DD/YYYY) Country of Citizenship (& Visa Status if not a U.S. Citizen) Gender:  Male  Female Do you intend to use Financial Aid towards program costs? Yes No Residency: In-state Out-of-state Applicant’s Contact Information Current Address: ___________________________________________________________________________________________________________ Street City State Zip Code Telephone Permanent Address: ________________________________________________________________________________________________________ Street City State Zip Code Telephone Contact details: ___________________________________ ________________________________________ Applicant’s E-mail Address Cell Phone Academic Information  Major(s) or  prospective major(s)______________________________________________________________ Your academic level during this study abroad program?  Sophomore  Junior  Senior  Graduate Student Consent for Release of Records and Information By signing below, I authorize release to any official representatives of 1) UNC Wilmington’s Office of International Programs, and 2) of cooperating institutions, any information related to my student academic performance, disciplinary action and medical records. I acknowledge that the purpose of the release is to assist in the assessment of my application for an education abroad program and to facilitate my study abroad experience. Furthermore, I understand that the presence of a disciplinary file or medical condition does not automatically disqualify me from an education abroad experience. Student Signature: _______________________________________ Date:____________________ Please see side 2UNCW Office of International Programs  Westside Hall  601 South College Road  Wilmington, North Carolina 28403-5965 Ph: 910-962-3685  Fax: 910-962-4053  [email protected]  www.uncw.edu/international Campus and Program Safety Questions Your “yes” answer to one or more of the following questions will not necessarily preclude your application. However, your failure to provide complete, accurate, and truthful information will be grounds to deny or withdraw your application, or dismiss you after enrollment. For the purpose of the following questions, “crime” or “criminal charge” refers to any crime other than a traffic-related infraction. You must, however, include alcohol or drug offenses whether or not they are traffic related. 1) Have you been convicted of a crime? Yes No 2) Have you otherwise accepted responsibility for the commission of a crime? Yes No 3) Do you have any criminal charges pending against you? Yes No 4) Have you ever been