general instructions for applying to suffolk university’s ... · university study abroad...

General Instructions for Applying to SuffolkUniversity’s Study Abroad Programs/Campuses:Please read these instructions carefully and keep them.This section contains instructions not only for completionof the application forms but also for later stages of theenrollment process. The application section includes aparticipation and indemnification agreement and anacknowledgment form. Please read both of these documents carefully and contact the Office of StudyAbroad Programs if you need any clarification.

■ In completing the application section, please type orprint clearly in ink. (If it is illegible, the application will not be accepted.) You may also apply online atwww.suffolk.edu/studyabroad.

■ Remember to sign the application, participation andindemnification agreement, and acknowledgment form. Reminder: Your parent/guardian must sign the participation and indemnification agreement.

■ Make sure you have completed your statement of purpose. This must be a typed, one-page essay addressing why you wish to study abroad.

■ Some programs require a specific host institutionapplication form, which must be typed or printedclearly in ink and submitted with the SuffolkUniversity study abroad application. To check if yourprogram requires this, please see the program description in our catalogue.

■ Students must obtain a housing form for their specific program (please see program description to check ifform is required).

■ Forward your official transcript to the Office of StudyAbroad Programs. We’ve included an official transcriptrequest form. Suffolk students: Use this form to requestthat the registrar send your transcript to our office.Non-Suffolk students and Incoming Exchange andStudy Abroad Boston students: Complete this formand tell us where and to whom to release your transcriptonce you have completed your program.

■ Students must submit the course selection form signedby their academic advisor, academic dean, and the deanof students.

■ Request a professor to complete the recommendationform enclosed in the application section or write a letterof recommendation on university letterhead. Have themsend it to the Office of Study Abroad Programs as soonas possible. (Make sure the professor writes your nameand program of interest on the recommendation form.)

■ Submit two passport-size photos (three passport-sizephotos for the Madrid campus), plus any passportphotos requested by the host institution. Even if youalready have your passport, we request photos to keepon file in Boston, and one or more to be sent overseaswith your completed application. Please print yourname on the back of each photo.

■ All applicants must check to see if their health care provider/insurance company covers international travelhealth insurance. To verify this, a letter must be sub-mitted from your insurance company stating what iscovered, and the Office of Study Abroad Programs willalso need a copy of your insurance card (front andback). If your health insurance provider/company doesnot cover international travel health insurance, pleasecontact the Office of Study Abroad Programs immedi-ately to obtain information on private providers to pur-chase while traveling.

■ International students applying to study at SuffolkUniversity Boston are required to submit the followingadditional documents:

• TOEFL score (written: 525/computer-based: 197)Admission is not guaranteed by specific scores, as a student’s entire application is considered.

• Financial statement (Bank letter stating you have aspecific amount in your account. This letter must be in English, and the funds must be in US dollars.Please contact the Office of Study Abroad Programsfor the specific amount.)

■ For non-Suffolk students, the completed applicationshould be accompanied by a nonrefundable $50 application fee. The application fee is waived for Suffolk students.

■ Make checks payable to Suffolk University. Make sure your name [applicant] is on the check, either imprinted on the top corner or in the memo section. If you are aSuffolk student, you must include your ID number onyour check.

STUDY ABROAD APPLICATION

Office of Study Abroad Programs8 Ashburton PlaceBoston, MA 02108-2770www.suffolk.edu/studyabroad

APPLICATION INSTRUCTIONS

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■ Applications are reviewed and sent overseas only whenthey are 100 percent complete.

■ Students who accept our invitation to join the programneed to mail a check or money order for a $500 (non-refundable) deposit that will be applied toward thetotal program fee/tuition.

■ The deadlines for applications are:

Summer Semester March 15Fall Semester April 15*Spring Semester October 15*

Most students apply well before the time stated to reservetheir spot. If space remains after the deadline, late applications will be reviewed on a case-by-case basis.

*Due to increased visa processing time, deadlines forStudy Abroad Boston (United States) and incomingexchange students are as follows:

Fall Semester March 15Spring Semester October 1

If Study Abroad Boston and exchange students’ applicationsare received after these dates, students will not be able topre-register for courses before arrival.

■ The remaining tuition balance is due:

Summer Semester April 1Fall Semester August 1Spring Semester December 15

■ If you are interested in studying for longer than onesemester, you must indicate this on your application.You will need to submit the same documents as listedabove but must have two sections of the courseauthorization form completed and signed by your academic advisor and college dean (if you plan to attend the same program for the entire academic year).

■ If you wish to study abroad at two different locations during the academic year (one semester at each location), you will need to submit two fullapplications and two sets of all required documents(one for each program).

■ Please advise the Suffolk University Office of StudyAbroad Programs of any changes in your address,telephone number, or email that arise after you submit your application.

■ Prior to departure from the United States, all participants will be required to submit a completeflight itinerary containing the date, time, airlines, flightnumber, terminal, etc., for flights to and from the destination country. Emailed copies from onlineservices (for example, Expedia) are accepted.

■ Make sure you have applied for your passport and visain a timely manner. (Please see program description tocheck if a visa is required.)

■ DAKAR CAMPUS ONLY: All students participating in the Dakar program will be required to submit a doctor’snote stating they have received the required shots andmedicine in order to travel to Senegal. If a student doesnot submit the required letter prior to departure from theUnited States, he/she will not be allowed to participate inthe program. For a list of shots and medicines, visitwww.cdc.gov/travel/wafrica.htm.

■ Mail your completed application* to:

Suffolk UniversityOffice of Study Abroad Programs8 Ashburton PlaceBoston, MA 02108Or drop off your completed application* at:

Office of Study Abroad ProgramsSuffolk University73 Tremont Street, 6th FloorBoston, MAPhone: 617.573.8072Fax: 617.305.1751 *Make sure you have all required documents; see application checklist.

■ BEEFORE YOU GO: Inform relevant campus officesof your study abroad status. Suffolk students must alertthe Office of Residence Life or the Off-CampusHousing Office, Student Accounts, and the Office of Student Financial Services.

■ ONCE YOU ARE ABROAD: If you are a Suffolk student, the University will email you important courseregistration information to help you schedule yourupcoming semester back on campus. If you do notcheck your University-provided account, be sure to forward your Suffolk email to your personal account.



APPLICATION INSTRUCTIONS, CONTINUED

❏ APPLICATION Complete all sections and remember tosign the application (pages 1–3).

❏ STATEMENT OF PURPOSE (question 20, page 2)

❏ RECOMMENDATION FORM Must be completed by a professor (page 4).

❏ ACKNOWLEDGMENT FORM Complete all sectionsand sign (pages 5 and 6).

❏ PARTICIPATION AND INDEMNIFICATIONAGREEMENT Complete all sections and sign (pages 7–9).

❏ OFFICIAL TRANSCRIPT (question 16, page 2).

❏ COURSE SELECTION (question 23, page 3).

❏ INTERNATIONAL TRAVEL HEALTH INSURANCELETTER

❏ COPY OF INSURANCE CARD (FRONT AND BACK)

❏ HOST INSTITUTION–SPECIFIC APPLICATIONFORM

❏ HOUSING FORM

❏ TWO PASSPORT-SIZE PHOTOS

❏ TRANSCRIPT REQUEST FORM

❏ FOR DAKAR CAMPUS ONLY: NOTE FROMDOCTOR

❏ APPLICATION FEE (for non-Suffolk students)

❏ FOR STUDENTS APPLYING TO SUFFOLK UNIVERSITY BOSTON CAMPUS ONLY: TOEFL results and financial documents.

❏ FLIGHT ITINERARY

APPLICATION CHECKLIST



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1. Full Legal Name

LAST (FAMILY) FIRST MIDDLE INITIAL BIRTHNAME (MAIDEN) NICKNAME

2. Permanent Address

STREET CITY STATE ZIP CODE COUNTRY

3. Current Mailing Address (IF DIFFERENT FROM ABOVE)

STREET CITY STATE ZIP CODE COUNTRY

4. Email (SUFFOLK ADDRESS) ____________________________________________ (PERSONAL ADDRESS) ______________________________________________________________

5. Phone (DAY) ______________________________________________________ (EVENING) ______________________________________________________________________

6. Social Security Number ____________________________________________ 7. Date of Birth __________________________ 8. Sex Male Female

9. City/Town of Birth ____________________________________________ 10. Country of Birth ______________________________________________________

11. Citizenship ______________________________________________ 12. Permanent Resident of (Country) ______________________________

13. Passport Number________________________________________ Issuing Country ________________________________________________________

14. I plan to study abroad at the following location:

STUDY ABROAD APPLICATION PAGE 1 OF 3


NAME

SUFFOLK UNIVERSITY ID NUMBER

Argentinann

Lincoln University College, Buenos Aires

Australia (CIS)nn

Bond Universitynn

La Trobe Universitynn

Macquarie Universitynn

Murdoch Universitynn

University of Newcastle

Austriann

Austria-Illinois Exchange, Vienna

Costa Ricann

International Center forSustainable Human Development(CIDH), San Jose

Czech Republicnn

Charles University, Prague

Denmarknn

Aalborg University, Aalborgnn

Aarhus School of Business (ASB), Aarhus

nn

Copenhagen Business School(CBS), Copenhagen

Englandnn

British American College atRegent’s College, London

nn

European Business School atRegent’s College, London

Francenn

CAVILAM, Vichynn

École Nationale Superieure dePhysique de Marseille, Marseille

nn

École Superieure de Gestion(ESG), Paris

nn

Euromed Marseille École deManagement, Marseille

nn

La Sorbonne, Parisnn

Pôle Universitaire Léonard de Vinci, Paris

Germanynn

Justus Liebig University (JLU), Giessen

Greecenn

American College ofThessaloniki (ACT), Thessaloniki

Irelandnn

University College Cork, Cork

Italynn

Florence University of the Arts,Florence

nn

John Cabot University, Romenn

Lorenzo de’ Medici, Florencenn

The Mediterranean Center forArts and Sciences, Sicily

nn

Palazzo Rucellai, Florencenn

Studio Art Centers International(SACI), Florence

Japannn

Kansai Gadai University, Osakann

Ritsumeikan University, Kyotonn

Sophia University, Tokyo

Mexiconn

Tecnologico de Monterrey, multiple cities

nn

Universidad Iberoamericana, Mexico City

Monaconn

International University ofMonaco (IUM), Monte Carlo

New Zealandnn

University of Auckland–Auckland

nn

Victoria University–Wellington

Norwaynn

Aalesund University College(AAUC), Aalesund

Senegalnn

Suffolk University DakarCampus, Dakar

South Koreann

Yonsei University, Seoul

Spainnn

Suffolk University MadridCampus, Madrid

Sweden

nn

Stockholm University School of Business, Stockholm

Taiwannn

Tamkang University, Taipei

Turkey nn

Istanbul University, Istanbulnn

Yeditepe University, Istanbul

United Statesnn

National Student Exchangenn

Suffolk University BostonCampus, Boston, Massachusetts

Vietnam nn

Hoa Sen University, Ho ChiMinh City

Interfuturenn

(Intercultural Studies for the Future)Independent Research Project (By invitation only. A separate application is required.)

Internshipsnn

EPA Internshipsnn

International-Internships.comnn

International Partnerships ofService Learning and Leadership(IPSL)

nn

OtherInstitution ____________________Country______________________

UNTIL WHEN?

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15. Program Information:

I plan to begin studies in

Fall 20____ Winter 20____ Spring 20____

Summer 20____ Academic Year 20____ to 20____

16. Academic Background Information

COLLEGE

CITY STATE COUNTRY

Year: Freshman Sophomore Junior Senior

Graduate–level

Credits completed __________________________________________

Cumulative GPA (on a 4.0 scale) _____________________________

Major __________________________________________________

Minor __________________________________________________

Projected Graduation Date __________________________________

17. Suffolk University students only

Are you a resident student? Yes No

Do you receive financial aid? Yes No

18. Transcript Information: Please send official transcripts to:

Office of Study Abroad Programs 8 Ashburton PlaceBoston, MA 02108-2770

OR DROP OFF ON-CAMPUS AT:

Office of Study Abroad Programs 73 Tremont Street, 6th Floor

19. How did you learn about Suffolk University Study

Abroad Programs?

20. Statement of Purpose

Please attach a separate typed page explaining why you wish tostudy abroad.

Agreement/Applicant’s Signature I accept responsibility that the information on this application is complete and accurate. Iunderstand that falsification or omission of information could resultin disqualification. My signature below certifies that during myenrollment in a study abroad program, I understand I am stillresponsible for meeting all applicable deadlines at my home insti-tution (i.e., financial aid, tuition payment, graduation, etc.).

21. Parent/Guardian Information

a. Father Guardian Living Deceased

FIRST NAME INITIAL LAST NAME

EMAIL

STREET ADDRESS

TOWN/CITY STATE/ZIP CODE COUNTRY

Home telephone ________________________________________

Work telephone ________________________________________

Other ____________________________________________________

Fax ______________________________________________________

b. Mother Guardian Living Deceased


EMAIL

STREET ADDRESS


Home telephone ________________________________________

Work telephone ________________________________________

Other ____________________________________________________

Fax ______________________________________________________

22. Emergency Contact Information

b. Mother Father Contact information is the same

Other (Relationship to you) ________________________________


EMAIL

STREET ADDRESS


Home telephone ________________________________________

Work telephone ________________________________________

Other ____________________________________________________

Fax ______________________________________________________

XAPPLICANT’S SIGNATURE DATE



NAME


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23. Course Selection

Please indicate the courses you’d like to take while studying abroad and for which semester. Course information for Boston study abroad is available at www.suffolk.edu. Course information for Madrid study abroad is available at www.suffolk.es. All other program course informationmay be obtained through the Office of Study Abroad Programs. You must fill out one chart for each semester you plan to study abroad. Please listyour choice of five courses, along with four alternative courses, per semester.

SEMESTER YEAR COURSE NUMBER COURSE NAME CREDITS WILL TRANSFER BACK AS:

SEMESTER YEAR COURSE NUMBER COURSE NAME CREDITS WILL TRANSFER BACK AS:

24. Transfer Credit Information (Undergraduates Only)

To be completed by the administrator responsible for awardingtransfer credit at your home institution.

NAME OF APPLICANT

The above student is applying for a study abroad programthrough Suffolk University with the expectation that the hours ofcredit earned abroad will transfer directly toward the degree inprogress at our institution.

I confirm that the applicant’s selected courses are acceptable to thisinstitution for transfer credit provided a grade of __________ or better is achieved in each course. Also, I confirm that to the best ofmy knowledge the student is in good standing at our institution.

nn

This student is enrolled as a full-time student in good standing.

nn

This student has permission to study abroad through SuffolkUniversity.

ADVISOR’S SIGNATURE DATE

COMMENTS

DEAN’S SIGNATURE DATE

Dean’s signature not required for students studying at the Madrid campus

TO BE COMPLETED BY THE DEAN OF STUDENTSnn

This student has never been on academic probation. If the student is or has been on academic probation, pleaseexplain:

________________________________________________________

nn

This student has never been involved in any disciplinary problem(s) while enrolled at this college/university. If the student has had disciplinary problems, please explain:

________________________________________________________

YOU ARE NOT DONE!

This application is not complete until you complete the following pages:

All applicants: Recommendation Form, page 4Acknowledgment Form, page 5Participation and Indemnification Agreement, pages 7–9

International non-Suffolk student applicants:Remember to submit financial documents and TOEFL scores with your application.

X

ALT

ALT

ALT

ALT

(ALT = Alternative Courses)



NAME


Recommendation information to be completed by the evaluator.

EVALUATOR’S NAME

STREET ADDRESS


Home telephone ____________________________________________

Work telephone ____________________________________________

Fax ______________________________________________________

Email ______________________________________________________

EVALUATOR’S SIGNATURE DATE

a. How long have you known the applicant? _____________________

b. In what capacity?

c. Please describe the applicant as a student:

Excellent

Above average

Average

Below average

Insufficient record to judge

d. Please provide a brief statement about the student that addresses thestudent’s strengths and weaknesses as they relate to the proposed off-campus study experience. For example, please evaluate the student’sability to tolerate differing viewpoints, motivation, personal maturity,emotional stability, ability to cope with difficulties, and leadershipskills. Include your recommendation and any other information thatyou feel would be relevant to the application.

ALL APPLICANTS MUST COMPLETE THIS FORM

Study Abroad Program of Interest: ____________________________________________________________________________________________

X

STUDY ABROAD RECOMMENDATION FORM PAGE 4


NAME


Acknowledgment

I, (print full name)

__________________________________________________________confirm my decision to participate in the study abroad program in(country)

__________________________________________________________for the (circle one) Fall / Spring / Summer / Wintersemester of (year) 20_____ or for the academic year of 20____ –20_____ (years).

In order to obtain the agreement of Suffolk University to maintain mystudent status and provide academic credit toward my program atSuffolk for the courses I take during my period of study abroad, I acknowledge that I am aware of the following requirements:

Approval of Course Requirement

I acknowledge that I am aware that Suffolk University will not give mecredit for any courses that I take abroad unless I have received priorwritten authorization from my advisor and/or the dean of my college forthose particular courses. I also understand that Suffolk will not credit anywork done after the end of the term that was not approved by my advi-sor and/or the dean of my college. I acknowledge that I have beenadvised that it is not possible to obtain approval to extend a period ofstudy abroad; and that, if I decide to stay abroad longer, I will notreceive any credits for the courses taken without authorization. Iacknowledge that it has been explained to me that I must have writtenapproval for all courses for which I expect to receive credit from Suffolkfrom my advisor and dean prior to departure. I understand that if Idecide to drop a course and add a different course, this new courseneeds to be either one of my previously approved alternative courses, orI must receive approval via email from my academic advisor. I will notifythe Office of Study Abroad Programs and the dean’s office of this newlyapproved course. I understand there are no exceptions to this rule.

Minimum Grade Requirement

I acknowledge that I understand that I will only receive credit fromSuffolk for courses in which I have completed all required course workand received a grade of C or better from my host institution. I under-stand that any grade below a C will not be transferred to SuffolkUniversity and will not appear on my transcript. (Note: Suffolk studentsstudying at Suffolk overseas campuses will have their grades trans-ferred back as is, so they will appear on official transcripts and affect cumulative GPAs.)

For Suffolk University Degree Candidates Who Are Within 30 Credits of Graduation

I acknowledge that I am aware that, if I am within 30 credits of completion of a Suffolk University degree program, the only studyabroad programs that will provide credit toward my degree require-ments are those offered at Suffolk University’s campuses in Madrid,Spain, or Dakar, Senegal; but I may request written consent from the dean of my school to participate in another study abroad programfor credit during my final 30 credits.

Dropping Out of Study Abroad

I acknowledge that it has been explained to me that I must notifySuffolk’s Office of Study Abroad Programs and my host institution inwriting if I decide to drop out of my study abroad program before thecompletion of the courses in which I have enrolled.

Cancellation Policy

Because Suffolk University makes financial commitments on yourbehalf well in advance of the program start date, refunds can only bemade in accordance with the terms listed below.

A student who withdraws voluntarily will receive the following refund:

• Withdrawing more than 30 days prior to a program’s commencement will result in a refund of all fees paid less the application fee (for non-Suffolk students) and the $500 program deposit.

• Withdrawing less than 30 days prior to a program’s commencement will result in no refund.

Note: All voluntary cancellations must be documented in writing to theOffice of Study Abroad Programs.

In cases where Suffolk University is forced to cancel or suspend a pro-gram or in the case of serious documented illness, the followingrefund policies will be applied:

• If the program has not yet begun, all funds will be refunded, less the application fee (for non-Suffolk students).

• If the program has begun, Suffolk University will refund any por-tion of the student’s expenses (excluding travel expenses) that hasnot been used or committed less the application fee (for non-Suffolkstudents).


STUDY ABROAD ACKNOWLEDGMENT FORM PAGE 5


NAME


Cancellation Policy, continued

Note: Cancellation or suspension of any program will result if 1) theUnited States Department of State issues a travel warning advising UScitizens not to travel to a particular country or, if in the country, toleave, or 2) Suffolk University deems it necessary to cancel or suspenda program for any other reason. Any serious illness that causes a stu-dent to withdraw must be documented by a licensed US physician,with notification sent to the Office of Study Abroad Programs atSuffolk University.

I certify that I have read this acknowledgment in full and that I received satisfactory answers to all my questions about Suffolk’sstudy abroad requirements before signing it. I further certify that I haveread the literature presented to me by Suffolk University’s Office ofStudy Abroad Programs and agree to comply with all the terms andconditions stated therein. I further acknowledge that by signing thisdocument I and/or my parent/guardian (if I am under the age of 18)are making legally binding statements that are intended to preventme/us from bringing claims against Suffolk University.

SIGNATURE OF APPLICANT

DATE

SIGNATURE OF PARENT/GUARDIAN (IF APPLICANT IS UNDER 18 YEARS)

DATE


X

X

STUDY ABROAD ACKNOWLEDGMENT FORM PAGE 6


NAME



Suffolk University offers its students the opportunity to participate in anumber of programs of study in other countries. Some of these studyabroad programs are offered through Suffolk University facilities andothers are provided through the facilities of foreign universities. Anystudent wishing to participate in study abroad must take into consider-ation the risks involved in doing so. It is neither physically possible noreconomically feasible for Suffolk University to act as the guarantor ofthe safety of students studying in countries far away from Boston andin institutions unrelated to Suffolk. Therefore, Suffolk University canonly make study abroad programs available to students who expresslyagree to accept responsibility for their safety while studying abroad.

Submission of this document with all required signatures is an essentialpart of demonstrating eligibility to participate in the study abroad pro-gram and serves three important purposes. The first is confirmation thatthe student whose parents/guardians sign the form is permitted to takepart in a study abroad program. The second purpose is to state theagreement of the student’s family and Suffolk University as to the alloca-tion of the risks of 1) the student’s travel to and in the city and countrywhere he/she will be studying; 2) living away from home during theperiod of study abroad in an unfamiliar location; and 3) participating inthe activities that make up the particular study abroad program in whichthe student will be enrolled. The third purpose is confirmation that SuffolkUniversity and the institution the student will be attending have parentalauthorization to obtain emergency medical care for the student, should itbecome necessary during the course of the study abroad program.Please read the language of these three provisions carefully and do nothesitate to call the director of study abroad programs at SuffolkUniversity, Youmna Hinnawi, at 617.573.8072 if you have questions. Itwill not be possible for a student to participate in a study abroad pro-gram unless this form is returned with appropriate signatures.

Students considering participation in study abroad programs shouldbe aware that Suffolk University cannot guarantee that all advertisedofferings will be available as described or without alterations andthat, between the printing of a catalog or brochure describing a pro-gram and a date of enrollment, foreign universities may make unan-nounced changes in course offerings and prices, and/or foreignaffairs considerations may require cancellation of a program. SuffolkUniversity must therefore retain the right to alter the content of andfees for study abroad programs without notice.

1. Parental Permission To Participate

As a custodial parent/guardian of (please print student’s name)

___________________________________________________________,

I have given her/him my permission to participate in the SuffolkUniversity study abroad program at (please print name of foreign/hostinstitution)

___________________________________________________________.

Before signing this permission form, I had the opportunity to satisfymyself as to the adequacy and safety of the arrangements for the studyabroad program at the host institution. I am familiar with the mentaland physical health of my child/ward and his/her ability to travel tounfamiliar places and be exposed to people of different ethnic, cultural,and linguistic backgrounds. My permission for my child/ward to partic-ipate is based upon my belief that she/he has the maturity and self-confidence to be able to respond appropriately to the challenges thathe/she will encounter during the study abroad program, as they havebeen described in the printed materials that I have been given.

SIGNATURE OF PARENT/GUARDIAN OR SPOUSE

DATE

PRINT FULL NAME OF PARENT/GUARDIAN OR SPOUSE

In consideration of Suffolk University’s willingness to allow me to partic-ipate in a study abroad program, I agree to comply with the rules forstudent conduct and good citizenship established by Suffolk Universityand the foreign institution I will be attending. I understand that failureto do so can lead to disciplinary sanctions, including required with-drawal from the program. I also understand that I will bear the finan-cial cost of any such disciplinary sanctions, including lost tuition andrepatriation.

SIGNATURE OF STUDENT

DATE

X

X

STUDY ABROAD PARTICIPATION AND INDEMNIFICATION AGREEMENT PAGE 7


NAME


2. Risk Sharing And Indemnification Agreement

I/We recognize that there are risks to a student’s person and propertyinvolved in air travel, surface transport, and in staying in hotels, hos-tels, dormitories, and private homes in an unfamiliar foreign country.I/We also understand that Suffolk University could not afford to offer abroad range of study abroad programs if it was required to bear thesole financial responsibility for those risks. Therefore, in order toinduce Suffolk University to make the program available to me/mychild/ward, I/we agree to share the risk of loss arising from injury tome/my child/ward and/or my/her/his property with SuffolkUniversity by entering into this indemnification agreement in whichI/we accept responsibility for all losses, except those caused exclusive-ly by the negligence of Suffolk University and/or its agents.

I/We have reviewed the plans for the program and recognize that useof regularly scheduled airlines to provide transportation between ourhome and foreign countries involves risks to person and property,which may include serious injury and death, and I/we agree toaccept those risks. From my/our review of the plans for the program,I/we am/are aware that I/my child/ward will also be exposed to therisks of surface travel in cars, trains, taxis, and buses while participat-ing in the program, and I/we accept the responsibility for those risks.I/We have reviewed the arrangements for the program and under-stand that I/my child/ward will be staying in various kinds of publicaccommodations with other students from the host country and othercountries, and I/we accept the risk that injury may occur to me/mychild/ward, while living in those accommodations. I/We have alsoreviewed the description of the academic and extracurricular pro-grams that will take place during the program and recognize thatattending classes and student activities and sightseeing in foreigncountries will expose me/my child/ward to the risks inherent in those activities, and I am/we are willing to accept responsibility for those risks.

I/We understand that participants in the program will be exposed to foreign countries with different standards, laws, and customs, withwhich participants will be expected to conform, even if very differentfrom conditions in the United States. I/We understand that neitherSuffolk University nor the host will provide or be responsible for thecost of criminal or civil legal proceedings, fines, or representation by an attorney.

I/We confirm to Suffolk University and the host institution our accept-ance of the obligation to pay for any medical treatment that the studentmay require while participating in the program and also confirm thatI/we have obtained all the insurance to cover medical costs, includingevacuation to the United States, that I/we feel is necessary and appropriate.

On the basis of my review of the plans for the program, and to induceSuffolk University and the host institution to allow me/my child/ward to participate in the program, I, (please print the student’s name)

___________________________________________________________,

and for myself and my heirs, successors and assigns, and I, in mycapacity as parent/ward of the student just named, agree to indemnifySuffolk University and the host institution and their trustees, governingbodies, officers, employees, and agents (the “Indemnitees”) for any sumsof money for which the Indemnitees may become liable as a result ofany claim, suit, or cause of action that I or my heirs, legal representa-tives, successors, and assigns, or I as representative of my child/wardmay have, now or in the future, arising out of my/my child/ward’s par-ticipation in the program, unless the claim, suit, or cause of action arisessolely and exclusively from the negligence of the Indemnitees, which Ihave not waived or released by signing this form.

I/We have read all of this Parental Risk Sharing and IndemnificationAgreement, and I/we have satisfied myself/ourselves that I/we understand what it means.

SIGNATURE OF STUDENT

DATE

PLEASE PRINT FULL NAME OF STUDENT


DATE

PLEASE PRINT FULL NAME OF PARENT/GUARDIAN OR SPOUSE

X

X



NAME


As the parent/guardian of (please print the name of the student)

___________________________________________________________, a student participating in the program, I authorize physiciansemployed by Suffolk University and/or the host institution or engagedby Suffolk University and/or the host institution to provide medicalcare to my child/ward while he/she is away from home and partici-pating in the program, including examining, treating, and prescribingmedications for her/his care. I understand that Suffolk Universityand/or the host institution will, to the greatest extent possible, consultwith me concerning the reasons for and effects of all such care.Recognizing that it may be impossible to reach me in situations inwhich the physicians treating my child/ward believe that beginningtreatment is medically necessary, I authorize Suffolk University and/orthe host institution to commence treatment when, in the professionaljudgment of the physicians involved, such treatment is medically neces-sary, even if I have not yet been consulted. In authorizing such emer-gency treatment, I agree to accept the determination of the treatingphysician or surgeon that the treatment or examination rendered wasmedically necessary to protect the life, health, or mental well-being ofmy child/ward. I give this authorization on the condition that the treat-ing physician will attempt to contact me, if at all possible, before thetreatment or examination is rendered.


DATE

PLEASE PRINT FULL NAME OF PARENT/GUARDIAN OR SPOUSE

Medical/Contact Information

My child/ward is entitled to medical insurance benefits under our policy with (please print the name of your medical insurer/HMO)

____________________________________________________________.

Our policy is number (please provide the number of the medical insurance policy)

____________________________________________________________.

*In case of emergency, I can be reached at the following telephone numbers:

DAYTIME TELEPHONE NUMBER

EVENING TELEPHONE NUMBER

OTHER TELEPHONE NUMBER

Backup Contact (i.e., different from above—grandparent,aunt, or uncle)

PRINT NAME OF BACKUP CONTACT

RELATIONSHIP TO STUDENT

TELEPHONE NUMBER

3. Medical Treatment Authorization

*It is very important to provide the Office of Study Abroad Programswith emergency contact information. It is the only means we have to provide you with up-to-date information regarding your son ordaughter in case of an emergency.

X



NAME


1. Academic History

When submitting your application, you must provide evidence ofyour academic background. List all universities you have attend-ed, starting with the most recent.

a.

UNIVERSITY NAME

CITY COUNTRY

DATE ATTENDED

b.

UNIVERSITY NAME

CITY COUNTRY

DATE ATTENDED

c.

UNIVERSITY NAME

CITY COUNTRY

DATE ATTENDED

2. Please list all courses in progress at the time of this application:

3. English Requirements

All international applicants are required to provide proof of Englishproficiency by any of the following means (please check one):

Test of English as a Foreign Language (TOEFL)(minimum score: 525 / 197 computer-based)

English Language Proficiency Test (ELPT) (minimum score: 956)

Successful completion of English program

Score ____________________ Test Year ____________________

Please provide original verification of test scores (no copies).

4. Financial Evidence

US immigration law requires that you provide sufficient evidence ofavailable funds for the cost of your education and living expenseswhile staying in the United States. Below are the estimated costsfor a full-time undergraduate student for one semester.

Based on 2009–20010 rates

Tuition $13,604

Living Expenses $7,147

Books and Insurance (REQUIRED) $1,800

Total per semester $22,551

*Additional computer fees are applicable to all students takingcomputer classes.

NAME

I understand I’m required by US immigration law to provideSuffolk University with sufficient evidence of funds to completelycover the cost of my education and living expenses while I’m inthe United States.

APPLICANT’S SIGNATURE DATE

INTERNATIONAL STUDENTS COMING TO THE US MUST COMPLETE THIS FORM

Any international student applying to study abroad through the Suffolk University Boston campus must complete this form.

X

INTERNATIONAL STUDENTFINANCIAL STATEMENT PAGE 10


NAME


5. Sponsor’s Statement

I am fully aware of the cost of tuition and living expenses atSuffolk University, and I assume full financial responsibility for theabove named student.

SPONSOR’S NAME

RELATIONSHIP TO THE APPLICANT

SPONSOR’S ADDRESS

CITY STATE

ZIP COUNTRY

TELEPHONE

FAX

EMAIL

SPONSOR’S SIGNATURE

DATE

6. Financial Support Documents

You will need to provide official documentation verifying attainable funds in the amount specified by the Office ofStudy Abroad Programs. The verification of funds can bemade by:

An official letter drafted by the bank on the bank’s letterhead verifying said funds (must be in US dollars)An official scholarship letter (government, CSN,Lanekassen, company, private)

To the best of our knowledge the above named sponsor has at this time sufficient funds to provide support for the abovenamed student for attendance at Suffolk University. This state-ment will in no way obligate said bank or any of its branchesand officials for any financial liability.

BANK OFFICIAL’S SIGNATURE

DATE

BANK OFFICIAL’S NAME (PLEASE PRINT)

BANK OFFICIAL’S TITLE

NAME OF BANK

BANK’S TELEPHONE NUMBER

7. Agreement /Applicant’s Signature

I accept responsibility that the information on this application is complete and accurate. I understand that falsification or omission of information could result in disqualification. My signature below certifies that during my enrollment in a study abroad program, I understand I am still responsible for meeting all applicable deadlines at my home institution (i.e., financial aid, tuition payment, graduation, etc.).

SIGNATURE OF INTERNATIONAL APPLICANT

DATE

X

X

INTERNATIONAL STUDENTFINANCIAL STATEMENT PAGE 11


NAME
