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INSTRUCTIONS FOR STUDENT FORMS

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					                                                                            North Carolina Central University
Faculty-led                                                                     Office of International Affairs
School of Law Costa Rica                                                                        Study Abroad
Summer 2011
                                                INSTRUCTIONS FOR STUDENT FORMS

Program Name: NCCU School of Law Costa Rica Program

Use the instructions below as you complete the items on the Student Checklist.
1. BPLI Law School Application
    • Fill out with your personal information

2. Official Transcripts (Law School only)
    • Allow ample time for the Registrar to process your order well before the deadline
    • Submit in a sealed and signed envelope

3. Grade point Average Agreement
    • After reading the document, make sure you SIGN YOUR NAME AT THE BOTTOM

4. NCCU Study Abroad PARTICIPANT DATA FORM 1
    • Fill in your personal information

5. NCCU Study Abroad COURSE TRANSFER FORM 2
    • Fill in your personal information at the top
    • OBTAIN YOUR ADVISOR’S SIGNATURE
    • Ms. Foushee will obtain the remaining signatures

6. NCCU Study Abroad PARTICIPANT AGREEMENT 3
    • Fill in your personal information on page 1
    • After reading the document, make sure you SIGN YOUR NAME ON PAGE 3

7. NCCU Study Abroad EMERGENCY –MEDICAL FORM 4
    • Fill in your personal information
    • Make sure you SIGN YOUR NAME under “Medical Release Agreement” AND “Consent for Medical Treatment”

8. Copy of Passport
    • Don’t forget to SIGN your passport
    • Turn in a copy with your complete forms packet if you already have your passport or turn in a copy to Ms. Foushee as
        soon as you receive it
             o Copy the inside cover with your picture and personal info and signature page

9. Copy of Flight Itinerary
    • Turn in a hardcopy or email your itinerary to Ms. Foushee as soon as you book your flight

10. OPTIONAL - Application for study abroad and/or consortium agreement (Scholarships and Student Aid Form)
    • Fill in your personal information at the top
    • Make sure you SIGN YOUR NAME at the bottom

11. OPTIONAL - Request to Transfer Funds (Scholarships and Student Aid Form)
    • Fill in your personal information at the top
    • Indicate that the REFUND CHECK SHOULD BE RELEASED TO YOUR STUDENT ACCOUNT
    • Make sure you have DIRECT DEPOSIT ON YOUR STUDENT ACCOUNT

12. OPTIONAL - Online Summer School Application for Financial Aid
    • Go to http://www.nccu.edu/admissionsandaid/scholarshipandaid/summerschool.cfm
    • Enter your username and password to access the form
    • Complete and print the form and SIGN YOUR NAME
NOTE: Students using financial aid should set up DIRECT DEPOSIT with Student Accounting.

NOTE: All UNC-system students participating in study abroad must have HTH Worldwide Health Insurance. The Office of
International Affairs will obtain HTH Worldwide Health Insurance for you using the information on your Participant Data
Form. The cost of the insurance is included in your program fee and will be paid by the program. You will receive your
insurance card via an email prior to your departure. See Attached Handout for Costa Rica Health Information.
                                                                 North Carolina Central University
Faculty-led                                                          Office of International Affairs
School of Law Costa Rica                                                             Study Abroad
Summer 2011
                                                                  STUDENT CHECKLIST

Program Name: NCCU School of Law Costa Rica Program
Submission Deadline: MARCH 25, 2011
Submit to: ARMINTA FOUSHEE
           274 Albert L. Turner Law Building
           Phone: 919-530-6505
           Fax: 919-530-6339
           afoushee@nccu.edu

Submit the following items in ONE COMPLETE PACKAGE in the ORDER
LISTED BELOW:
[ ] BPLI Law School Application

[ ] Official Transcripts (NCCU School of Law only)

[ ] Grade point Average Agreement

[ ] NCCU Study Abroad PARTICIPANT DATA FORM 1

[ ] NCCU Study Abroad COURSE TRANSFER FORM 2

[ ] NCCU Study Abroad PARTICIPANT AGREEMENT 3

[ ] NCCU Study Abroad EMERGENCY –MEDICAL FORM 4

[ ] Copy of Passport

[ ] Copy of Flight Itinerary (Turn in as soon as you book your flight)

[ ] OPTIONAL - Application for study abroad and/or consortium agreement (Scholarships and Student
Aid Form)

[ ] OPTIONAL - Request to Transfer Funds (Scholarships and Student Aid Form)

[ ] OPTIONAL - Online Summer School Application for Financial Aid
(http://www.nccu.edu/admissionsandaid/scholarshipandaid/summerschool.cfm)

Professor Kimberly Cogdell:                                Office of International Affairs Contact:
Turner Law School Office 122                               Renee Hoehne
919-530-6618                                               Study Abroad Coordinator
kcogdell@nccu.edu                                          Lee Biology Bldg Rm 103
                                                           919-530-7714 or rhoehne@nccu.edu
                                        Biotechnology and Pharmaceutical Law Institute
                                       North Carolina Central University - School of Law




                                  Summer Study Abroad Program, May 23 – June 17, 2011
                                  Location: University of Costa Rica, San Jose, Costa Rica

                                                                 Application


First Name:                                       MI:                                                          Last Name:

Current Address:

City:                                             State:                                                       Zip:

Home phone:                                       Mobile phone:                                                Fax:

Email:

Emergency Contact Name:                           Address:            Phone:               Mobile phone:                 Email:

Name as it appears on passport: ________________                                 Date applied for: __________________
Passport number: _______________

Expected Graduation Date: ___________                                 Grade Point Average: __________________

I am currently a law student in good standing at NCCU School of Law G

I am currently a student in good standing enrolled in the _________________________ graduate school
program at NCCU G

I am currently a student in good standing enrolled in the _________________________ graduate school
program at __________________________ G

Have you traveled outside of the United States before? Yes G No G

Do you have special medical and or dietary needs that need accommodation? Yes G No G

______ Are you interested in enrolling in the BPLI Certificate Program?

______ Are you interested in enrolling in the DRI Certificate Program?



Signature of applicant:                                               Date:

Application materials must be received by March 25, 2011. All applications received after March 25h will be subject to a
$250 late fee. The program is limited to 20 U.S. students and will be filled on a first come first served basis. A student will be enrolled in the
program after the payment of all fees. A deposit of $500, drawn on a U.S. bank and made payable, by a single check, to the order of
Biotechnology and Pharmaceutical Law Institute is due by February 25th in order to guarantee a space in the program.
Please deliver application to: Arminta Foushee, Program Coordinator for the BPLI, by noon on March 25, 2011. Her office is located in room
274. Phone: 530-6505. Email: afoushee@nccu.edu, Fax: 919-530-6339.
               GRADEPOINT AVERAGE AGREEMENT
               BIOTECHNOLOGY AND PHARMACEUTICAL LAW INSTITUTE
               NORTH CAROLINA CENTRAL UNIVRSITY SCHOOL OF LAW
                          STUDY ABROAD PROGRAM

This AGREEMENT of HAVING a 2.3 GRADE POINT AVERAGE upon the onset of
participation in the Study Abroad Program in Costa Rica is made by and between
Professor Kimberly Cogdell and the undersigned participating student.

I. Term
The Study Abroad Program for the summer of 2011 will begin on May 23, 2011 and shall
continue until June 17, 2011. Upon entering this program, student participants shall
have a cumulative grade point average of 2.3.

III. Purpose
The purpose of the agreement is to ensure that students meet the grade point average
requirement established by the American Bar Association and the agreement between
the Biotechnology and Pharmaceutical Law Institute and the ABA for student
participation in the Study Abroad Program.

III. Terms of Payment
There is a $500 non-refundable application deposit for enrollment in the Study Abroad
Program in Costa Rica sponsored by BPLI. Students making an application and deposit
that do not have the required 2.3 grade point upon entering the program will forfeit the
opportunity to participate in the program as well as the $500 deposit.

This Agreement shall be binding upon the director of the Study Abroad Program, and
student applicant.

The Biotechnology and Pharmaceutical Law Institute and the student have caused this
Agreement of a 2.3 grade point average requirement for participation in the Summer
Study Abroad Program to be executed on the dates indicated below, effective as of the
date indicated above.




   Student (Signature)          Program Director (Signature)           Date Signed
06092009




                                                                                                                                     1
                                                                                    North Carolina Central University
                                                                                        Office of International Affairs
                                                                                                        Study Abroad
                                      STUDY ABROAD PARTICIPANT DATA FORM
       PLEASE PRINT CLEARLY

 Name                                                                                                       Banner ID          820
                    FIRST                        MIDDLE                                  LAST

 Gender     MALE / FEMALE               Date of Birth               /      /         Ethnicity/Race

 OPTIONAL: Do you have any special needs or require special services during your                         YES / NO
 program (i.e. dietary considerations, learning aids or handicapped access)? If yes,
 please describe on a separate sheet.

 Campus/Semester Address

 Permanent Address

 Campus Phone                                                           NCCU Email (Required)

 Home Phone                                                             Personal Email

 Cell Phone

 Major                                                            Minor                                                    CGPA

 Classification at start of Study Abroad SO JR SR GRAD LAW                                Academic Advisor
                                                (30-59) (60-95) (96+)




 Expected Graduation Date (Month/Year)                        /

 Study Abroad Destination       San Jose, Costa Rica                                      Program Dates May 23-June 17, 2011
                                City, Country                                                           Term(s) and Year

 Host/Foreign University       University of Costa Rica                        Consortium/Program Partner      NCCU School of Law

 Country of Citizenship (Specify Visa Status if not a U.S. citizen)

 Passport Expiration Date (If you do not have a passport, apply ASAP and
 submit the Expiration Date to OIA as soon as your passport arrives.)


 How do you intend to finance your study abroad program? (Circle all that apply)
    Federal/State Financial Aid               Personal savings                    Parent/Family Contributions
    Student Loan                               Scholarships                       Other

       I certify that all my statements on this application are complete and accurate to the best of my knowledge.


       Print Name                                                   Signature                                                  Date
        
                              North Carolina Central University is committed to equality of educational opportunity and does
                                not discriminate against applicants, students, or employees based on race, color, national
                                                          origin, religion, sex, age or handicap.
  06092009                                                                                                                                          North Carolina Central University


PLEASE PRINT CLEARLY
                                                                                             INSTRUCTIONS:
                                                                                                                                                        Office of International Affairs
                                                                                                                                                                        Study Abroad
                                                                                                                                          STUDY ABROAD COURSE TRANSFER FORM

                                                                                             1. Make an appointment with your academic advisor to discuss your academic goals and program choices and
                                                                                                                                                                                                      2
Name                                                                                         review your host institution’s web site or course catalog to select your desired courses while abroad.
                                                                                             2. With your selections, complete the “Courses at Host Institution Abroad” section below. List your preferred
Banner ID    820                                                                             courses first, followed by several alternates in case your preferred courses are not available once you are abroad.
                                                                                             Keep a description of each course abroad for your academic advisor to use to determine the NCCU course
Major(s)/Minor
                                                                                             equivalent.
CGPA                                                                                              •    Make sure you meet the requirements for full-time status (Undergraduate-12 hrs/semester, 6 hrs/summer;
                                                                                                       Graduate/Law-9 hrs/semester, 4.5 hrs/summer).
Classification at start of Study Abroad         SO       JR       SR    GRAD       LAW            •    In the “Credit Units” column, make sure to note the credit value (i.e., 15 points, 7.5 ECTS) assigned by
                                                                                                       your host institution.
Expected Graduation Date (Month/Year)                         /                                   •    It is your responsibility to make sure you do not take any classes for which you have already received
Study Abroad Destination (City, Country)        San Jose, Costa Rica                                   academic credit.
                                                                                             3. Meet with your advisor to complete the “NCCU Course Equivalent” section below. Then, obtain all the
Program Dates      May 23 – June 17, 2011                                                    approval signatures in the order listed below.
                                                                                             4. For students receiving financial aid: Your financial aid forms cannot be processed until this form has been
Host/Foreign University:       University of Costa Rica                                      completed and your study abroad (STAB) credit hours have been processed by the University Registrar.
                                                                                             5. Before you leave your host country, check with your host institution to find out what you need to do to have
Consortium/Program Partner         NCCU School of Law                                        them mail an official transcript to NCCU OIA. An official transcript is required for you to receive course credit.

        Courses at Host Institution Abroad (Completed by Student)                                                        NCCU Course Equivalent (Completed by Advisor)
  Subject    Course                                                                 Credit        Subject      Course                                                                 Credit     OIA USE ONLY
  Abbrev.    Number                           Course Title                          Units         Abbrev.      Number                           Course Title                          Hours        Billable Hrs
    Law         9567                Comparative Bioethics and Policy                     2           Law         9567                Comparative Bioethics and Policy                    2
    Law         9566             Comparative Limited Liability Companies                 1           Law         9566             Comparative Limited Liability Companies                1
    Law         9506                   Negotiation All Around Us                         2           Law         9506                  Negotiation All Around Us                         2


                                                   TOTAL Credit Hours                                                                                 TOTAL Credit Hours
  Subject    Course                                                                 Credit        Subject      Course                                                                 Credit     OIA USE ONLY
  Abbrev.    Number                   ALTERNATE Course Title                        Units         Abbrev.      Number                  ALTERNATE Course Title                         Hours        Billable Hrs




        Obtain Approvals in Order Listed                                     Name (Please Print)                                                Signature                                           Date
                          Academic Advisor (Major)
                          Department Chair (Major)                Wendy Scott
                               College Dean (Major)               Raymond Pierce
       Law School Registrar (Law Students Only)                   Carol Chestnut
                       Office of International Affairs            Renee Hoehne
                                 University Registrar             Jerome Goodwin
 08182009




                                                                                                           3
                                                                     North Carolina Central University
                                                                         Office of International Affairs
                                                                                         Study Abroad
                                STUDY ABROAD PARTICIPANT AGREEMENT
       PLEASE PRINT CLEARLY

       STUDENT NAME:

       BANNER ID NUMBER:            820

       STUDY ABROAD DESTINATION:             San Jose, Costa Rica

       PROGRAM DATES:         May 23 – June 17, 2011

       HOST/FOREIGN UNIVERSITY:           University of Costa Rica

       CONSORTIUM/PROGRAM PARTNER:                NCCU School of Law

       I hereby agree as follows:

  I.      PROGRAM ARRANGEMENTS:
            I understand that although North Carolina Central University (NCCU or the University) will attempt
            to implement the program as described in its documentation, it reserves the right to change or cancel
            the program at any time and for any reason it deems sufficient to promote program objectives, safety
            issues, or institutional needs. I further understand that if changes or cancelation occurs, I may not
            have any fees or expenses refunded. In addition, I understand that I am responsible for all program
            fees as well as all debts, costs, and expenses incurred abroad other than those covered by the required
            program fees. Also, I understand that if I leave or am excluded from the program for any reason
            there will be no refund of fees paid or expenses incurred. Moreover, I agree to fulfill all mandatory
            pre-departure requirements. I understand that I am responsible for maintaining the required course
            load while abroad. I agree to attend classes regularly unless prevented by illness or unavoidable
            circumstances. I will save copies of all relevant coursework for review by my advisor. Additionally,
            I understand that I am responsible for ensuring the transfer of study abroad/foreign transcripts to
            NCCU. Furthermore, I understand that I am responsible for my own accident, travel, baggage,
            missed flight and life insurance coverage.

 II.      ASSUMPTION OF RISK:
            I fully understand that this program will expose me to many risks associated with foreign travel and
            participation in a program abroad. I fully accept this possibility of risk and assume all risks
            associated with this program.

III.      STANDARDS OF CONDUCT AND ACKNOWLEDGEMENT OF MY RESPONSIBILITY
            I agree to comply with all rules, regulations, and laws of the respective countries to be visited, all
            travel regulations, any rules or precautions issued by the University, its representatives, by any
            associated institutions or organizations, or the United States government. I agree to comply with the
            NCCU Student Handbook throughout the program. I agree that if I violate those standards, rules, or
            regulations, I may be disciplined, including immediate exclusion from the program. I explicitly
            waive all claims based on alleged inadequate disciplinary procedures. I understand that any
            additional costs incurred, as a result, will be my responsibility. In addition, I understand that I may
            be subject to further disciplinary, civil and/or criminal action upon my return to the University.




       Study Abroad Participant Agreement                                                                    Page 1 
IV.      SAFETY ISSUES AND LIMITS ON RESPONSIBILITY:
           I understand that there are safety risks associated with the program and travel and that the University
           is not responsible for such injuries, damages, or loss. In addition, I understand, acknowledge, and
           agree that the University cannot and does not:
                   o Guarantee the safety of participants or eliminate risk from the study environment;
                   o Monitor or control daily personal decisions; and
                   o Prevent participant from engaging in illegal, dangerous, or unwise activities.

 V.      HEALTH AND HEALTH INSURANCE:
           I agree to obtain and maintain appropriate insurance through the University or compatible to that of
           the University, with a minimum coverage of medical evacuation and repatriation, and abide by the
           conditions imposed by the carriers for the entire duration of my study abroad program. I agree that I
           have or will have consulted with a qualified medical doctor or comparable health care provider
           regarding my personal needs such that there are no health related reasons or problems that preclude
           or restrict my participation in the program. I am aware of all my applicable personal medical needs.
           I understand that travel abroad may expose me to certain conditions, disease and illnesses. Therefore,
           I have acquired or will have acquired before the start of the program, all immunizations and
           medications for the countries that I am visiting, required by the United States Center for Disease
           Control. I understand that I am financially responsible for all of my costs and expenses whether or
           not covered by insurance.

VI.      RELEASE OF CLAIMS AND WAIVER OF LIABILITY:
           I therefore agree to release, waive liability, hold harmless, discharge, and indemnify North Carolina
           Central University, the UNC Board of Governors, University officials, employees, agents, and
           volunteers from any liability, claim, demand, costs, or expenses that may be asserted arising from or
           by reason of personal injury; illness; property damage; any cause or occurrence beyond the control of
           the University or its agents, including natural disasters, wars, civil disturbances, terrorist acts; or
           other consequences or events arising from my participation in the program. This release also binds
           my parents, siblings, heirs, executors, successors, and assigns.

VII.     INTERPRETATION OF AGREEMENT:
            I agree and acknowledge that the laws of North Carolina govern this agreement and that North
            Carolina will be the forum for any lawsuit, hearings, or adjudications filed incident to this agreement
            or to the program. Moreover, I agree that if any provision or aspect of this agreement be found to be
            unenforceable that all remaining provisions of the agreement will remain in effect.




      Study Abroad Participant Agreement                                                                    Page 2 
VIII.      VOLUNTARY ACKNOWLEDGEMENT:
             I acknowledge that I have read this entire document and agree and fully understand its terms. This
             agreement supersedes any previous or contemporaneous understandings that I may have had with the
             University, its agents, whether oral or written. I knowingly and voluntarily agree to its terms. I
             further understand that before I sign this agreement, I have the right to consult with the advisor,
             counselor, or attorney of my choice. By signing it, I am assuming the above stated participant
             responsibilities. In addition, I represent that I am at least eighteen years of age or if not, I have
             secured below the signature of my parent or guardian, as well as my




        Name of Participant (Please Print)                               Date

        Signature of Participant

        Name of Parent/Guardian (Please Print)                           Date

        Signature of Parent/Guardian (if student is under 18)




        Study Abroad Participant Agreement                                                                 Page 3 
                                                                                                                                     4
06092009
                                                                                  North Carolina Central University
                                                                                       Office of International Affairs
                                                                                                       Study Abroad
                           STUDY ABROAD EMERGENCY-MEDICAL FORM
        
       Student Name
                                               FIRST                             MIDDLE                             LAST
       Date of Birth                 /              /                  Gender        MALE / FEMALE
        
                                                              EMERGENCY CONTACTS

       Primary Emergency Contact Name                                             Secondary Emergency Contact Name

       Relationship to Student                                                    Relationship to Student

       Home Phone                             Work Phone                          Home Phone                            Work Phone

       Cell Phone                             Alternate Phone                     Cell Phone                            Alternate Phone

       Address                                                                    Address

       City, State, Zip                                                           City, State, Zip
        
                                                              MEDICAL INFORMATION

       Physician’s Name                                                           Insurance Company

       Physician’s Phone Number                                                   Policy Number

       Current Medical Conditions

       Current Medication Being Taken

       Allergies (General or to medication)
        
                                                        MEDICAL RELEASE AGREEMENT
       “I certify that I am in good physical and mental health and that I do not suffer from any special mental or physical problem or condition
       that would prevent me from successfully taking part in study abroad and related travel activities.” If you are unable to sign, please explain
       on a separate sheet.


       Student Signature                                                          Parent/Guardian Signature (If under 18)

       Date                                                                       Date
        
                                                   CONSENT FOR MEDICAL TREATMENT
       “I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia and other medical and/or hospital procedures as may be
       performed or prescribed by the attending physician and/or paramedics for myself/my child and waive my right to informed consent of
       treatment. This consent applies only in the event that neither parent/guardian/spouse/designated other can be reached in the case of an
       emergency. In the event that it is necessary to rely on this consent, I agree to indemnify and hold North Carolina Central University and
       its agents harmless from the costs incurred for said emergency care and treatment, including attorney fees and costs incurred to recover
       said medical expenses.”


       Student Signature                                                          Parent/Guardian Signature (If under 18)

       Date                                                                       Date
        
               NORTH CAROLINA CENTRAL UNIVERSITY
                  Office of Scholarships and Student Aid
                         Study Abroad Guidelines

Timeline:       The processing cycle for Study Abroad is 4 to 6 weeks.

Eligibility:    Students who are enrolled at least on a half-time basis in a program that is
                approved by their department.

General Requirements:
  1. Student must have a valid Student Aid Report on file.
  2. Must submit to the Scholarships and Student Aid Office an approved Budget
      and schedule of classes provided by the Office of International Affairs (OIA)
  3. Prior to submission, must have registered for at least 6 (undergraduate) or
      4.5 (law/graduate) credit hours of study abroad classes.
  4. Classes must be coded as STBA (Study Abroad).

Documents required for Processing Study Abroad Application
  1. Registered courses must appear in Banner coded as STBA
  2. Budget approved by OIA (tuition, fees, room, board, transportation, personal expenses, etc.)
  3. Application for Study Abroad and/or Consortium Agreement)
  4. Request to Transfer Refunds Form
  5. Summer School Application (required for studying abroad for May, June or July).
  6. Approved Consortium Agreement completed by visiting institution


Please Note:
Financial aid funds may not be disbursed prior to your financial aid commitment to the
Study Abroad Program and/or visiting institution in which you are enrolled. It is the
student’s responsibility to make payment arrangements with the visiting institution. In
order for funds to be transferred, a Request to Transfer Refunds Form must be completed.
                     NORTH CAROLINA CENTRAL UNIVERSITY
                       OFFICE OF SCHOLARSHIPS AND STUDENT AID

    APPLICATION FOR STUDY ABROAD AND/OR CONSORTIUM AGREEMENT

Student’s Full Name: ___________________________________________________________________

SS#: _______________________________________ Banner ID: _820___________________________

Address (including city, state, zip):________________________________________________________

Telephone#:___________________________________ Fax#:__________________________________

Email address: ________________________________________________________________________

Study Abroad Address (Study Abroad Consortium Agreement will be submitted to this individual to complete
and return to North Carolina Central University. Please ensure that the information reported below is current):

Name: Professor Kimberly Cogdell

School: NCCU School of Law – University of Costa Rica Study Abroad Program

Address (including city, state, zip): 640 Nelson St. Durham NC 27707


Telephone #: 919-530-6618                                             Fax#: 919-530-6339

Email address: kcogdell@nccu.edu

Study Abroad Coordinator’s Name: Renee Hoehne

Telephone #: 919-530-7714                  Fax#: 919-530-7627                 Cell #:

Email address: rhoehne@nccu.edu

Please Note:
It is the student’s responsibility to make payment arrangements with the visiting institution and
meet the required payment deadlines. Financial aid will not cover deposits and/or payments
required before the scheduled refund dates. In order for funds to be transferred, a Request to
Transfer Refunds Form must be completed.

I certify that the information provided on this form is complete and correct to the best of my knowledge.
Also, I will notify the Office of Scholarships and Student Aid if I decide not to attend the Study Abroad
Program or change my Study Abroad address.
_______________________________________________                     _____________________
                     Student’s Signature                                        Date

                  North Carolina Central University ~ P.O. Box 19496, Durham, NC 27707
                      (919) 530-6180, Fax: (919) 530-7959 ~ email: vthorpe@nccu.edu
                 NORTH CAROLINA CENTRAL UNIVERSITY
                   OFFICE OF SCHOLARSHIPS AND STUDENT AID

                      REQUEST TO TRANSFER REFUNDS

I, _________________________________, Banner ID ______________________,
authorize North Carolina Central University to release the following refund
check(s) to ____________________________________________________________.

I understand that these funds will be used to support my participation in the Study Abroad
Program at North Carolina Central University.
__________________________________                          _______________________
        Student’s Signature                                            Date

   ----------------------------For Financial Aid Use Only-----------------------------

Fall:        ______ (yr.) ________              1st Refund of $__________
             ______ (yr.) ________              2nd Refund of $ __________

Spring:      ______ (yr.) ________              1st Refund of $__________
             ______ (yr.) ________              2nd Refund of $ __________

Summer I: ______ (yr.) ________                 1st Refund of $__________
          ______ (yr.) ________                 2nd Refund of $ __________

Summer II: ______ (yr.) ________                1st Refund of $__________
           ______ (yr.) ________                2nd Refund of $ __________

                                For Student Accounting:

Make Check(s) Payable to: ____________________________________________________
Address: ___________________________________________________________________
___________________________________________________________________________

Send to: _____________________________________________________________________
Address: ____________________________________________________________________
____________________________________________________________________________
                                                                                  North Carolina Central University
Faculty-led                                                                           Office of International Affairs
Costa Rica School of Law                                                                              Study Abroad
Summer 2011
                                                                         Costa Rica Health Information
Costa Rica Health Information
Information obtained from the Wake County Human Services Travel Nurse and the CDC 12-1-2010
For more detailed information, visit http://wwwnc.cdc.gov/travel/destinations/costa-rica.aspx

Before visiting Costa Rica, you may need to get the following vaccinations and medications for vaccine-preventable diseases
and other diseases you might be at risk for at your destination.

Note: Your doctor or health-care provider will determine what you will need, depending on factors such as your health
and immunization history, areas of the country you will be visiting, and planned activities.

To have the most benefit, see a health-care provider at least 4–6 weeks before your trip to allow time for your vaccines to take
effect and to start taking medicine to prevent malaria, if you need it. Even if you have less than 4 weeks before you leave, you
should still see a health-care provider for needed vaccines, anti-malaria drugs and other medications and information about
how to protect yourself from illness and injury while traveling.

Recommended Immunizations:
    •    Update routine shots such as measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine,
         poliovirus vaccine, influenza, chicken pox, etc.
    •    Hepatitis A
    •    Hepatitis B
    •    Typhoid

Malaria Information:
The Wake County Human Services Travel Nurse does not recommend antimalarial medication for individuals traveling to San
Jose, Costa Rica. As a general precaution, however, travelers to Costa Rica should use insect repellent and wear long pants
and sleeves, especially during the hours of dawn and dusk, to prevent mosquito bites.

Though your regular doctor or health-care provider will likely be able to provide routine and Hep A/B immunizations
and may be able to provide travel immunizations, the CDC recommends that you see a health-care provider who
specializes in Travel Medicine.

For travel immunizations and medications, make an appointment with-
Wake County Human Services
Public Health Center (Clinic E)
10 Sunnybrook Road, Raleigh
Call 919-250-3900 to make an appointment.
 M-F by appt only from 8:30-11:30 a.m. and 1-4 p.m.

Concentra Urgent Care – Shiloh Crossing
4104 Surles Court Ste. 11
Durham, NC 27703
919-941-1911
M-F 7:30am-8:00pm and Sat-Sun 10:00am-4:00pm

NOTE: CALL clinic of choice to make an appointment and confirm the services available as well as prices. Prices vary
depending on individual needs and provider. Health insurance usually does not cover travel immunizations and medications,
but you should check with your insurance provider.
NOTE: OTHER MEDICATIONS YOU MAY NEED
   • The prescription medicines you take every day. Make sure you have enough to last during your trip. Keep them in
      their original prescription bottles and always in your carry-on luggage. Be sure to follow security guidelines, if the
      medicines are liquids.
   • Medicine for diarrhea, usually over-the-counter.
   • If you wear glasses or contact lenses you should take an extra pair, as well as a copy of your prescription.

NOTE: OTHER ITEMS YOU MAY NEED
  • Iodine tablets and portable water filters to purify water if bottled water is not available.
  • Sunblock and sunglasses for protection from harmful effects of UV sun rays.
  • Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol.
  • To prevent insect/mosquito bites, bring:
       o Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible.
       o Insect repellent with at least 30% DEET.
       o Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide;
            these insecticides quickly kill flying insects, including mosquitoes.
       o Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and
            will be in malaria-risk areas. For use and purchasing information, see Insecticide Treated Bed Nets on the CDC
            malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and
            clothes.

				
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