Online Application for J Term Program

Eligibility and requirements for participation in an off-campus program:
I understand that: (Please check the boxes to indicate your agreement. All boxes must be checked.)
Only complete applications will be considered (with passport or photo ID photocopy).
The College has the right to cancel programs with low enrollment. If a program is cancelled, I may enroll in a different program or ask for a refund of the deposit.
I must have a minimum of a 2.0 grade point average and must meet any course prerequisites. Some courses are restricted to a specific major. Not all programs accept freshmen.
I may not apply if I am on academic or disciplinary probation. Students placed on academic or disciplinary probation after being accepted into a program will not be eligible to participate, and cancellation penalties will apply. The College has the right to screen students’ academic, disciplinary and medical histories and consider them in the selection process.
Program fees listed in the brochure and online are ESTIMATES. Occasionally, fees need to be adjusted because of unforeseen price increases, such as fluctuations in currency, fuel prices, and course enrollments.

I demonstrate these competencies: (Please check the boxes to indicate your agreement.)
Ability to be flexible and adapt to new environments
Ability to assume responsibility for my own medical and psychological needs
Maturity to respect the host culture as well as fellow program participants

Travel Documents: Include photocopy of ID (photo page) when turning in final application.
International programs: a valid passport (must not expire before July 1, 2014) or a copy of your passport application
U.S. programs: a driver's license or other state photo identity card

Timeline:
Spring deadline for application is April 19, 2013. The $500 deposit is due with the application. Remaining balance is due with fall tuition.
Fall deadline for applications (for programs with enrollment still open) is Sept. 23, 2013. The $500 deposit is due Sept. 30. Balance is due Oct. 10. Should there be a change in the program fee, students will have two weeks from the notification date or until the last day of classes—whichever is shorter—to pay.

Program:

Student Information

Your name as it appears on your passport (for international travel) or US ID (for domestic travel):
Last Name:
First/Middle Name:
Hartwick Student ID#:
Major:
Minor, if any:
Gender: Male    Female
Graduation Year (yyyy):
GPA:
Campus box #:
Hartwick E-mail:
Other E-mail:
E-mail Printable Forms to Me:
Cell Phone:
Date of Birth: Month: Day: Year:
Passport (for international destinations):
If your passport application is pending, enter "pending" in this field and enter
your driver license number or state-issued ID and state in the line below.		 Passport Number: 
Passport Expiration Date: 
Driver's license or other state photo ID number
(for domestic programs):		   State:
Country of Citizenship:
For international programs, please include a photocopy of the photo page of your passport to complete your application. For domestic programs, please include a photocopy of your driver's license or other state-issued photo identity card.

Parent Information

Parent/Guardian Last Name:
Parent/Guardian First/Middle Name:
Phone:
Street Address:
Street Address Line 2:
City:
State:  Zip Code:
Country:
Parents' Preferred E-mail Address:
E-mail Printable Forms to My Parents:

Please indicate your reasons for applying to this program:

What courses have you taken that are relevant to this off-campus program?

Briefly mention any previous experience with travel or residence in other countries or regions of the U.S.

Sign electronically by typing your name and the date:
Student Signature:  Date: 

Emergency Contact Information

The parent or guardian will be considered the first emergency contact.
Second Emergency Contact:

Last Name:
First/Middle Name:
Relationship to Participant:
Street Address:
Street Address Line 2:
City:
State:  Zip Code:
Country:
Home Phone:
Cell Phone:
Work Phone:
E-mail Address:

Third Emergency Contact (optional):

Last Name:
First/Middle Name:
Relationship to Participant:
Street Address:
Street Address Line 2:
City:
State:  Zip Code:
Country:
Home Phone:
Cell Phone:
Work Phone:
E-mail Address:

By signing your name below, you permit Hartwick College to release information to the parent/guardian and alternate contacts you have entered above. This information may include, but is not limited to, pre-departure information regarding the program, billing statements and other financial information, and information regarding your whereabouts and/or participation in the program. The College may make these disclosures for any purpose that it deems necessary or advisable in connection with its administration and operation of the program, including, without limitation, enforcement of the requirements for participation in the program.

I permit Hartwick College to release information to the persons I have indicated above.
Student Signature:  Date: 

Hartwick College often reprints pictures submitted to the Office of Global Education in promotional material. If you are willing to have a picture of you included, please indicate here:   I agree to having my photograph(s) reprinted or shared:  Yes   No

            

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