Overseas Off-Campus Programs

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					Overseas & Off-Campus Programs
Lewis & Clark College                         Phone: 503-768-7295                        Year of Study in Munich
MSC 11                                        Fax: 503-768-7300                         Application Information
0615 S.W. Palatine Hill Road                  Email: overseas@lclark.edu
Portland, OR 97219                            www.lclark.edu/~overseas                        Page 1

Application Deadlines


Completed applications will not be accepted after the application deadline OR once 40 applications for a specific
program have been submitted to the Overseas & Off-Campus Programs Office, whichever comes first.

Munich Deadline: February 05, 2010 Note:        application due to Pacific University by January 29th,2010




Important Information


Before you begin the application process, consult with your academic advisor or department chair to discuss the
appropriateness of the program you are interested in attending and the application deadlines and procedures.
Incomplete applications will not be accepted.

CHECKLIST Make sure the following are completed before turning in your application:

        Faculty Advisor Signature
        Release & Agreement signatures (parental signature needed if under 21)
        Academic Integrity signature
        Third-party release
        Passport Info.
        Mailing address other than a PO Box
        E-mail address
        Student ID number
        Health Certificate
        Short Essays
        Information Sheet
        Social Security Number (needed in order to create a Lewis & Clark ID number for you)

    In addition, you are required to turn in:
               12 passport-sized (2 x 2) color pictures with your name, program, and what term you’re
                   applying for written on the back of each one with a non-smearing pen. (we recommend Action
                   Fast Photo, located at 9889 SW Barbur Blvd., just south of the Safeway- show your ID to receive a
                   discount).
               A statement concerning your college level standing (sophomore, junior, senior) from your registrar.
                   The University of Munich requires this record as a condition of your admission into the regular
                   university classes.
               Two certified copies of college or university transcript (please follow schedule below). The transcript
                   must have an impression seal and signature of the Registrar.

                      o    The first transcript is needed at the time of application.

                      o    The second should be mailed to Lewis & Clark College AS SOON as your Spring
                           2010 grades are posted. The University of Munich’s deadline for this is June 12th. If
                           your institution does not normally process transcripts by this date, you must make
                           arrangments with your registrar to have an exception made to mee t the deadline.

                 Three confidential academic references, on forms provided, from three faculty members,
                  includingat least one German professor. All reference forms must be received before your file can
                  be considered complete. You will not be accepted until you have a complete file.
Overseas & Off-Campus Programs
Lewis & Clark College                           Phone: 503-768-7295                        Year of Study in Munich
MSC 11                                          Fax: 503-768-7300                          Application Procedures
0615 S.W. Palatine Hill Road                    Email: overseas@lclark.edu
Portland, OR 97219                              www.lclark.edu/~overseas                           Page 2 of 15

We welcome your interest in the Year      In addition to the application, please        imposed by host country government
of Study in Munich Program and look       arrange to have the materials outlined        are the responsibility of the student
forward to working with you during        on the application checklist, by              participant.
the application and selection process.    February 5, 2010, the application             All dormitories provide cooking
Please read this information carefully    deadline.                                     facilities adequate for students to
and keep it for future reference.                                                       prepare at least some of their meals.
                                          The Decision                                  The large student cafeteria, the
Application Procedure                     Notification of acceptance or non-            Mensa, is located near the university
Enclosed in this application packet       acceptance will be sent as soon as            and offers a substantial midday meal
are several forms including: the          possible after March 1, 2010. Upon            at a moderate cost. Assuming that
Application for Admission; the Health     acceptance you will be instructed             students will take most of their meals
Certificate; the Reference forms; and     about additional pre-program                  at the Mensa or in the dormitory, the
the Release & Agreement form. All         requirements.                                 College estimates food cost at $225
reference forms must be received                                                        to $275 per month.
before your file can be considered        From the beginning of the
complete. Please note that it is          application process until you                 2. Guarantee of the comprehensive
your responsibility to insure your        return from the program, our office           fee, set in advance of the program,
file is complete, including               will communicate with you via                 may require the College to absorb
references.                               email. For this reason, you must              unexpected inflation of cost.
                                          be able to use a program that                 Financial stability of the programs
It is important that you obtain a valid   opens attachments and check                   also requires the College absorb
passport as soon as possible. Note        your email every day.                         savings which may be achieved
that the program application requests                                                   through good management.
information contained in your             Advice to Applicants on
passport. U.S. passport applications      Restrictions and Conditions                   3. The resident director retains
are available at all Main Branches of     Applicable to All Programs                    ultimate responsibility for all
the U.S. Postal Service. If you do not                                                  expenditures from group funds.
have a valid passport, it is your         Upon acceptance the student will              Budget allocations for all services are
responsibility to inform us of the        receive a payment schedule                    mere guidelines and always tentative;
number as soon as possible or your        indicating a comprehensive fee for            when actual costs are less, the
application will be considered            the program and payment dates                 savings so achieved may be used at
incomplete.                               which must be met before departure.           the director’s discretion to reinforce
                                          Comprehensive fees are not itemized           weaker budgeted program areas or
If you are a studying here from           and assume the following:                     will revert to the College.
another country with an F1 Visa or
you are not a U.S. citizen and have       1. Comprehensive fees are "non-
some other type of immigration            itemized" in that they do not commit
status, you must inform us                The College to allocate specific
immediately of your particular            portions of the fee income to any
circumstances. Non-U.S. citizens          category or expense but commit it
require additional steps to process       only to provide the services offered
their visa into Germany.                  and described in special
                                          announcements, brochures, etc.
If you are a student of Reed College,     The fee includes coverage of room,
Willamette University, University of      tuitio, instructional fees, official health
Puget Sound, or Pacific University        examination and residence permit,
submit your completed application         and mandatory health insurance
directly to your study abroad office in   provided by the College during the
advance. Please check with your           program dates.
study abroad office for their
submission deadline.                      Not included are: transatlantic
                                          travel, meals during the 11-month
If you are a student of another           stay in Germany, books and supplies,
institution submit your completed         passports, incidental expenses and
application directly the Overseas &       personal travel arrangements,
Off-Campus Programs Office at             scheduled either before or after the
Lewis & Clark College.                    program. Any departure fees
Overseas & Off-Campus Programs
Lewis & Clark College                             Phone: 503-768-7295                           Year of Study in Munich
MSC 11                                            Fax: 503-768-7300                              2010-2011 Application
0615 S.W. Palatine Hill Road                      Email: overseas@lclark.edu
Portland, OR 97219                                www.lclark.edu/~overseas                                Page 3 of 15


Please type or print in CAPITAL LETTERS

Applicant Information

Legal name ______________________________________ Gender                    M    F 
         As it appears on your passport/government ID

Preferred name _________________________ Social Security No.__________________________ Birthdate _______________
                                                                                                   MM/DD/YY
Campus or Current address __________________________________________________________________________________
                                           number and street

_______________________________________________________________________________                      Valid until? _____________
city or town            state           zip

It is your responsibility to keep us updated anytime your address changes

Local phone number ___________________________________ Cell phone __________________________________

email ___________________________________________________________________________________________________
 You will be expected to check this email address daily prior to and throughout your participation on this program. You may provide
                                                      more than one address.


Permanent and Parent/Guardian Contact Information


Permanent address _________________________________________________________________________________________
                  number and street       city or town             state           zip

Permanent phone number __________________________________ Parent/Guardian Email _____________________________
                                                          For the purposes of sharing program information.

Should the program payment request be sent to this address?            Yes       No 

If no, please specify below the address to which the program payment request should be sent. Additional or Billing?


Additional Address (If your permanent address is a PO Box, please list a street address)


Address __________________________________________________________________________________________________
                 number and street       city or town             state           zip

Phone number __________________________________________                Parent/Guardian Email _____________________________
                                                                       For the purposes of sharing program information.

Should the program payment request be sent to this address?            Yes       No 

Billing Address (If your permanent address is a PO Box, please list a street address)

Address __________________________________________________________________________________________________
                 number and street       city or town             state           zip

Phone number __________________________________________                Parent/Guardian Email _____________________________
                                                                       For the purposes of sharing program information.
Should the program payment request be sent to this address?            Yes  No 

Emergency Contact Information
Emergency Contact Name(s) ____________________________________________________________________

Address______________________________________________________________________________________
                                                                                  city                    state       zip
Email_____________________ Phone Number(s)____________________________________________________
Overseas & Off-Campus Programs
Lewis & Clark College                               Phone: 503-768-7295                            Year of Study in Munich
MSC 11                                              Fax: 503-768-7300                               2010-2011 Application
0615 S.W. Palatine Hill Road                        Email: overseas@lclark.edu
Portland, OR 97219                                  www.lclark.edu/~overseas                                 Page 4 of 15




Overseas and Off-Campus Program Participation History

Have you previously participated on an overseas program affiliated with Lewis & Clark College?           Yes  No 
If yes with which program? _________________________________________

Have you previously participated on an overseas program not affiliated with Lewis & Clark College?       Yes  No 
If yes with which organization? _________________________________________


Academic Qualifications

Applicant must be in good academic standing to participate on a program. Applicant must also meet all prerequisites for the
program to which application is being made. Please be advised that your code of conduct records will be reviewed.

Present cumulative grade point average ___________

Previous term's grade point average (choose only one):
          College ___________ Name of institution ______________________________________________________
          High School ___________
          Other Institution ___________

Class standing at the beginning of the program                 Sophomore        Junior       Senior

Your major or intended major ________________________________________________________________________________

Last/Current language level class taken for intended program (if applicable): ___________________________________________


Faculty Advisor Signature

I have met with the student applicant and agree that this program is appropriate for my academic curriculum.

Name of Advisor __________________________________________________________________________________________

Faculty Advisor Signature __________________________________________________ Date __________________________




Passport Information

In order to participate on an overseas program, you must have a passport that is valid for at least 6 months BEYOND the end of
your program, which would be approximately February 2012, if you leave immediately following the end of the program. If you don’t
have a passport, or if it will expire, please apply for one as soon as possible as the University of Munich requires this information to
be admitted. There is information on applying for one on our website, <www.lclark.edu/~overseas>.

Passport Number _________________________             Place of Issue ___________________________________
If you do not have a passport, please state date when you applied for your passport________________________

Date of Issue ____________________________                    Expiration Date __________________________________
Overseas & Off-Campus Programs
Lewis & Clark College                              Phone: 503-768-7295                            Year of Study in Munich
MSC 11                                             Fax: 503-768-7300                               2010-2011 Application
0615 S.W. Palatine Hill Road                       Email: overseas@lclark.edu
Portland, OR 97219                                 www.lclark.edu/~overseas                                 Page 5 of 15



References

Provide the names of three professors you have asked to complete the attached reference forms. Please include their addresses
and departments/occupation. Transfer and first year students may have one reference from a previous academic instructor. Please
note that it is your responsibility to insure your file is complete, including references.

Academic Reference

Name __________________________________________________________________ Department _____________________

Academic Reference

Name __________________________________________________________________ Department _____________________

Academic Reference

Name __________________________________________________________________ Department _____________________




Financing Questions


1. Are you satisfied, on the basis of the "Advice to Applicants" section (page 2), that you can finance an overseas/off-campus
   program?      Yes  No 

2. Do you anticipate that you may have to stay out of college for a term after you return from your program to earn money for
   continuation of your education? Yes  No 




Third Party Release


In making application for this Lewis & Clark Overseas/Off-Campus Program, I consent to the release of my college transcripts,
references, and/or other confidential materials to the Director and administrative staff of the Overseas & Off-Campus Programs
Office, to faculty involved in the selection process, and to any third party deemed necessary for use only in selection and operation
of the program for which I am applying.


Student Signature _______________________________________________________ Date ___________________________




Information Release (optional)



In making application for this Lewis & Clark Overseas/Off-Campus Program, I consent to the release of my college transcripts,
references, and/or other confidential materials to my parent(s) or guardian(s) for use only in operation of the program for which I am
applying.

Parent or Guardian name(s) ________________________________________________________________________________

Student Signature ________________________________________________________ Date _________________________
Overseas & Off-Campus Programs
Lewis & Clark College                              Phone: 503-768-7295                        Year of Study in Munich
MSC 11                                             Fax: 503-768-7300                           2010-2011 Application
0615 S.W. Palatine Hill Road                       Email: overseas@lclark.edu
Portland, OR 97219                                 www.lclark.edu/~overseas                             Page 6 of 15



Special Problems

     Do you smoke?                        Yes
                                          No

    Does it bother you if other people smoke?  Yes
                                               No

    Note any allergies or aversions to cold, heat, crowds, foods, religious beliefs, small children, animals, elderly
    people. Note any restrictions on physical activity or diet, whether imposed by parents, physician, religion, or self.
    Please use additional paper if needed.



    Do you suffer from any chronic illness (diabetes, seizure disorder, asthma, etc.)?          Yes
                                                                                                No
    If checked “yes,” please give details of onset and current treatment.




    Have you ever been treated for a psychological problem?     Yes
                                                                No
    If checked “yes,” please provide details about when and how you were treated, current symptoms and/or
    treatment, hospitalization, etc.




    Are you currently taking any medications?                 Yes
                                                              No
    If checked “yes,” please list.

Student Signature

I certify that the statements made throughout this application are true and correct.


Student Signature _____________________________________________________Date_____________________

Statistical Information

The following questions are optional. None of the information you provide will be used in a discriminatory manner. The information
is for statistical purposes only. How would you describe yourself? (Please check one)

   African American, Black                                                      Native Hawaiian, Pacific Islander
   American Indian, Alaskan Native (tribal affiliation)___________              Puerto Rican
   Asian American or Asian (country) ___________                                White, European American, Caucasian
   Hispanic, Latino (country) ___________                                       Multiracial (specify)
   Mexican American, Chicano                                                   _________________________________________
Overseas & Off-Campus Programs
Lewis & Clark College                       Phone: 503-768-7295                  Year of Study in Munich
MSC 11                                      Fax: 503-768-7300                      Health Certificate
0615 S.W. Palatine Hill Road                Email: overseas@lclark.edu
Portland, OR 97219                          www.lclark.edu/~overseas                        Page 7 of 15



Please have your physician complete this form and return it directly to the Overseas & Off-Campus
Programs Office, MSC 11. Faxed copies are not accepted.

Name ___________________________________________________________________________________________
      (Last)                              (First)                             (Middle)

Birth date ________________________     Student ID Number __________________________________________
                  MM/DD/YY
extension/local phone number ____________________ cell phone ________________________________________

Email __________________________________________



To the Physician:

The student presenting this certificate has applied for acceptance to an academic program conducted by Lewis &
Clark College in Germany. The program may be more demanding of physical and emotional energies than an
academic program on campus. A considerable amount of travel is involved under unpredictable conditions.

Certificate:
I have examined the above-named student as of ________________, 20______, and find the student free of
communicable disease and physically and mentally qualified for a program in the above location. Limitations or
conditions upon the activities of this student necessary for the safeguarding of health are as follows:




The following remedial measures before the program or during the program are recommended:




Allergies: ______________________________________________________________________________________

_______________________________________________________________________________________________


Signature of examining physician: __________________________________________________________________

Name __________________________________________________________________________________________

Address ________________________________________________________________________________________

Telephone ______________________________________________________________________________________

Date ___________________________________________________________________________________________
Overseas & Off-Campus Programs
Lewis & Clark College                    Phone: 503-768-7295                Year of Study in Munich
MSC 11                                   Fax: 503-768-7300                   Short Essay Section
0615 S.W. Palatine Hill Road             Email: overseas@lclark.edu
Portland, OR 97219                       www.lclark.edu/~overseas                    Page 8 of 15



Please follow these instructions carefully:
    • Answer the application questions using a computer-generated format using 12 point font.
    • Follow the minimum and maximum word guidelines for each question to ensure uniformity from all
       applicants.
    • Please make sure that you number each page and that you put you legal name, home institution,
       and student ID at the footer of each page.


1. How does this program contribute to your collegiate academic career? How does this program
contribute to your major curriculum? Have you discussed your participation on this program with your
major advisor or department chair? In regards to your participation on this program, what are the
recommendations of your advisor or department chair? (150-250 words)

2. Why are you applying to this particular program? How will your participation contribute to the program?
(150-250 words)

3. List the courses you have taken, the grades you have received, and the experiences you have had
using German. Be specific as to where you studied and for how long; degree of skill in reading, writing,
and speaking. If you have not met the minimum language requirement, please mention your plans for
fulfilling it. If applicable, please answer the same question about other languages you know. (150-250
words)

4. What evidence can you give of your ability to pursue the demands of this program with maximum of
initiative, persistence, and self-discipline? Cite papers you have written, projects you have carried to
completion, and responsibilities you have fulfilled, including offices held, previous background in courses,
and co-curricular activities. (150-250 words)


  ***Please submit the above questions generated on computer format using 12
  point font and include the following statement at the end of the document and
            include your signature and date as demonstrated below.***


        I certify that the above information furnished in this application is complete and accurate, to the
best of my knowledge, and that I agree to abide by the conditions outlined in your brochure YEAR OF
STUDY IN MUNICH. Also, in making application to this Lewis & Clark Year of Study in Munich program, I
consent to the release of my college transcripts and/or other confidential materials to the Director and
administrative staff of the Overseas & Off-Campus Programs Office and the faculty involved in the
selection process for use only in the selection and operation of the program for which I am applying.

Applicant's Signature               PLEASE READ ABOVE                         Date ________________
Overseas & Off-Campus Programs
Lewis & Clark College                        Phone: 503-768-7295                  Year of Study in Munich
MSC 11                                       Fax: 503-768-7300                     2010-2011 Application
0615 S.W. Palatine Hill Road                 Email: overseas@lclark.edu
Portland, OR 97219                           www.lclark.edu/~overseas                      Page 9 of 15

Information Sheet
This form will be submitted to the University of Munich so please type or print in capital letters. Incomplete forms are not
acceptable. If you are traveling with a non-US passport or you are in the US with a student visa you must work closely with
our office to determine the process for acquiring your visa to Germany. Once accepted into the program, it is your
responsibility to contact us and request additional help.


NAME: ___________________________________ CITIZENSHIP(S): ___________________

CLASS STANDING AS OF JUNE 2009:  Sophomore  Junior  Senior  Graduated


PERMANENT ADDRESS:




DATE OF BIRTH: _______ / ______ /________
                mo.       day      year

PLACE OF BIRTH (City, State, Country): _________________________________________


GENDER:     M      F        MARITAL STATUS: __________________________


PASSPORT NUMBER: __________________________


ISSUED AT: __________________________________


DATE OF ISSUE: _______/_________/___________
                 mo.       day      year


DATE OF EXPIRATION: ______ / ______ / _________
                     mo.      day       year


YEARS OF GERMAN STUDIED AT A COLLEGIATE LEVEL: ________________


MAJOR: ______________________________________
Overseas & Off-Campus Programs
Lewis & Clark College                  Phone: 503-768-7295                     Year of Munich
MSC 11                                 Fax: 503-768-7300                    2010-2011 Application
0615 S.W. Palatine Hill Road           Email: overseas@lclark.edu
Portland, OR 97219                     www.lclark.edu/~overseas                   Page 10 of 15




WHAT CLASSES WOULD YOU LIKE TO TAKE AT THE UNIVERSITY OF MUNICH ( E.G., CHEMISTRY,
COMMUNICATIONS, ART, ETC.):




HEALTH PROBLEMS (allergies, etc.):




SUMMER ADDRESS AND PHONE NUMBER (If more than one, please list with the dates):




PHONE NUMBER: (         ) _______________________

WHERE WOULD YOU LIKE US TO SEND YOUR MUNICH TRANSCRIPT? (Please indicate which office at your school
receives transcripts):
Overseas & Off-Campus Programs
Lewis & Clark College                         Phone: 503-768-7295                      Confidential
MSC 11                                        Fax: 503-768-7300                    Academic Reference
0615 S.W. Palatine Hill Road                  Email: overseas@lclark.edu           2010-2011 Programs
Portland, OR 97219                            www.lclark.edu/~overseas                  Page 11 of 15


Please give this form to a professor from whom you have recently taken a course.

Applicant's Name__________________________________________________________________________________
                        (Last)               (First)               (Middle)
Program _________________________________________ Semester _______________________

Applicant's signature in compliance with Public Law 93-380:

        I waive my right to view this evaluation.
        I do not waive my right to view this evaluation.

Signature ____________________________________________ Date __________________________


Please complete this form and return it to the Overseas & Off-Campus Programs Office (MSC 11), by the following
deadlines:

         Fall/Full Year Programs:                                October 26, 2009
         Spring/Domestic/Summer Programs:                        February 05, 2010

Name of Reference _____________________________________ Department ____________________________

1. How long have you known the applicant? _____________________________________________________________

2. In what course(s) have you taught the applicant? _______________________________________________________

3. Do you know of any reason that would cause you to hesitate to recommend this student for the
   overseas or off-campus program for which application has been made?




4. Please comment on the following: Academic ability, motivation, intellectual curiosity, unusual aptitude.
   Emphasize the areas where you feel your knowledge of the applicant is strongest.




5. What observations can you make about the applicant's qualities as a person (e.g., peer relations,
integrity, leadership potential, etc.)? Are there particular strengths or weaknesses of which we should
   be aware?




Signature ________________________________________________________ Date _______________________
Overseas & Off-Campus Programs
Lewis & Clark College                         Phone: 503-768-7295                      Confidential
MSC 11                                        Fax: 503-768-7300                    Academic Reference
0615 S.W. Palatine Hill Road                  Email: overseas@lclark.edu           2010-2011 Programs
Portland, OR 97219                            www.lclark.edu/~overseas                  Page 12 of 15


Please give this form to a professor from whom you have recently taken a course.

Applicant's Name __________________________________________________________________________________
                        (Last)                (First)              (Middle)
Program _________________________________________________________ Semester _______________________

Applicant's signature in compliance with Public Law 93-380:

        I waive my right to view this evaluation.
        I do not waive my right to view this evaluation.

Signature ________________________________________________________ Date __________________________



Please complete this form and return it to the Overseas & Off-Campus Programs Office (MSC 11), by the following
deadlines:
        Fall/Full Year Programs:                               October 26, 2009
        Spring/Domestic/Summer Programs:                       February 05, 2010

Name of Reference _________________________________________Department ____________________________

1. How long have you known the applicant? _____________________________________________________________

2. In what course(s) have you taught the applicant? _______________________________________________________

3. Do you know of any reason that would cause you to hesitate to recommend this student for the overseas or off-
   campus program for which application has been made?




4. Please comment on the following: Academic ability, motivation, intellectual curiosity, unusual aptitude.
   Emphasize the areas where you feel your knowledge of the applicant is strongest.




5. What observations can you make about the applicant's qualities as a person (e.g., peer relations,
   integrity, leadership potential, etc.)? Are there particular strengths or weaknesses of which we should be aware?




Signature ________________________________________________________ Date _______________________




Please give this form to a professor from whom you have recently taken a course.
Overseas & Off-Campus Programs
Lewis & Clark College                         Phone: 503-768-7295                      Confidential
MSC 11                                        Fax: 503-768-7300                    Academic Reference
0615 S.W. Palatine Hill Road                  Email: overseas@lclark.edu           2010-2011 Programs
Portland, OR 97219                            www.lclark.edu/~overseas                  Page 13 of 15



Applicant's Name __________________________________________________________________________________
                        (Last)                (First)              (Middle)
Program _________________________________________________________ Semester _______________________

Applicant's signature in compliance with Public Law 93-380:

        I waive my right to view this evaluation.
        I do not waive my right to view this evaluation.

Signature ________________________________________________________ Date __________________________



Please complete this form and return it to the Overseas & Off-Campus Programs Office (MSC 11), by the following
deadlines:
        Fall/Full Year Programs:                               October 26, 2009
        Spring/Domestic/Summer Programs:                       February 05, 2010

Name of Reference _________________________________________Department ____________________________

1. How long have you known the applicant? _____________________________________________________________

2. In what course(s) have you taught the applicant? _______________________________________________________

3. Do you know of any reason that would cause you to hesitate to recommend this student for the overseas or off-
   campus program for which application has been made?




4. Please comment on the following: Academic ability, motivation, intellectual curiosity, unusual aptitude.
   Emphasize the areas where you feel your knowledge of the applicant is strongest.




5. What observations can you make about the applicant's qualities as a person (e.g., peer relations,
   integrity, leadership potential, etc.)? Are there particular strengths or weaknesses of which we should be aware?




Signature ________________________________________________________ Date _______________________
Overseas & Off-Campus Programs
Lewis & Clark College                         Phone: 503-768-7295                            Academic Integrity
MSC 11                                        Fax: 503-768-7300                                  Agreement
0615 S.W. Palatine Hill Road                  Email: overseas@lclark.edu                    2010-2011 Programs
Portland, OR 97219                            www.lclark.edu/~overseas                              Page 14 of 16




         Program

         Between: Lewis & Clark College, its Trustees, Officers, Faculty and Agents                  “The College”

         And:                                                                                        “Participant”


All students on any Lewis & Clark College Overseas and/or Off-Campus Program are obligated and required to
adhere to the Academic Integrity Policy as published in the Lewis & Clark College Catalog’s “Policies and
Procedures” which are stated below:

1. Principles of Conduct. The community of scholars at Lewis & Clark College is dedicated to personal and academic
excellence. Joining this community obligates each member to observe the principles of mutual respect, academic integrity, civil
discourse, and responsible decision making.

2. Academic Integrity. Academic integrity finds its genesis in the fundamental values of honesty, tolerance, respect, rigor,
fairness, and the pursuit of truth. Scholarship is at the heart of this academic community, and trust between faculty and
students is essential to the achievement of quality scholarship. At times scholarship is collaborative, at times independent. All
sources, both written and oral, should be properly cited. Acts of academic dishonesty are contrary to the mission of the College
and constitute a serious breach of trust among community members.

3. Academic Integrity in Practice. 3.1 Lewis & Clark College believes that each member of the community is responsible
for the integrity of his or her individual academic performance. In addition, because each act of dishonesty harms the entire
community, all individuals--students, faculty, and staff members alike--are responsible for encouraging the integrity of others:
by their own example, by confronting individuals they observe committing dishonest acts, and/or by discussing such actions
with a faculty member or academic dean, who will respect the confidentiality of such discussions. When any individual violates
this community's standards, the College is committed as a community to take appropriate steps to maintain standards of
academic integrity.

3.2 Acts of academic dishonesty involve the use or attempted use of any method or technique enabling a student to
misrepresent the quality or integrity of his or her academic work.

3.3 Academic dishonesty with respect to examinations includes but is not limited to copying from the work of another,
allowing another student to copy from one's own work, using crib notes, arranging for another person to substitute in taking an
examination, or giving or receiving unauthorized information prior to or during the examination.

3.4 Academic dishonesty with respect to written or other types of assignments includes but is not limited to: failure to
acknowledge the ideas or words of another that have consciously been taken from a source, published or unpublished; placing
one's name on papers, reports, or other documents that are the work of another individual, whether published or unpublished;
flagrant misuse of the assistance provided by another in the process of completing academic work; submission of the same
paper or project for separate courses without prior authorization by faculty members; fabrication or alteration of data; or
knowingly facilitating the academic dishonesty of another.

3.5 Academic dishonesty with respect to intellectual property includes but is not limited to theft, alteration, or destruction of
the academic work of other members of the community, or of the educational resources, materials, or official documents of the
College.



Signature of Participant                                                  Date


NOTE: Applicant must sign and return the original with the application; this form CANNOT be accepted as a fax or copy It is
highly recommended that the applicant and Parent or Guardian keep copies for their files.
Overseas & Off-Campus Programs
Lewis & Clark College                         Phone: 503-768-7295                                Release and
MSC 11                                        Fax: 503-768-7300                                   Agreement
0615 S.W. Palatine Hill Road                  Email: overseas@lclark.edu                     2010-2011 Programs
Portland, OR 97219                            www.lclark.edu/~overseas                               Page 15 of 16



Program:

Between:          Lewis & Clark College,                                            “The College”
                  its Trustees, Officers, Faculty and Agents

And:                                                                                “Participant”

And:                                                                                “Parent or Guardian”

        Participant desires to be accepted into the College’s Overseas and Off-Campus Study Program. Participant
and/or Parent or Guardian understand that for a variety of social, societal, political, legal, and other reasons, there
may be inherent risks in any overseas and off-campus program.

         Participant and/or Parent or Guardian understand the risks include, by way of example and not limitation, the
following: travel by air, train, bus, car, and other modes of transportation, potential political violence, hazardous
weather, absence of reliable and accessible communication, and other unforeseen events.

         Participant agrees it is his(er) sole responsibility to be familiar with the physical and/or mental demands
associated with the above named program. With these demands in mind, Participant represents that s(he) has no
physical or mental limitation or medical condition which, to the best of her(is) knowledge would endanger her(him)self
or others if participant partakes in this program.

         As a condition to acceptance, the parties agree as follows:

           1. General Release and Indemnification. Participant and, if applicable, Parent or Guardian agree(s) to:
defend, release, indemnify, hold harmless and forever discharge Lewis & Clark College and any cooperating
institution and their officers, employees, trustees, insurers and agents from and against any and all claims, demands,
actions or causes of actions, whether know or unknown, relating to or arising out of or in conjunction with any
damage, death or other consequences to real or personal property, any accident, illness, personal injury, death or
other consequences that may result from Participant’s participation in the overseas or off-campus activity for which
Participant is applying.

          2. Related to Safety and Medical Needs. Participant and, if applicable, Parent or Guardian, grant the
College full authority to take whatever action the College, in its discretion, determines to be warranted to preserve the
health and safety of Participant with regard to Participant’s participation in activities, whether organized or self-
directed, while on the overseas or off-campus program for which Participant is applying.

We understand that actions the College may take include, but are not limited to, prohibiting any activities the College
deems to be risky and placing participant in a hospital, or, if no hospital is reasonably available, place Participant in
the care of a local physician, at Participant’s expense. The College will undertake to make reasonable effort to
communicate with Parent or Guardian before Participant is hospitalized, or subjected to injections, anesthesia, or
surgery, if the nature of the medical emergency so permits. If the College in its discretion determines that Participant
should be returned to the United States for medical treatment, Participant and, if applicable, Parent or Guardian,
agree to reimburse the College for any transportation costs incurred, less any savings the College realizes as a
consequence of Participant’s non use of the return ticket provided for in the announcements of the program.

         3. Termination or Modification of Program. The College may cancel or alter the Overseas or Off-
Campus Study Program at any time if in its discretion it determines the conditions of force majeure (such as natural
disasters, epidemics, political and economic crises, low enrollment or unavailability of a program leader) would make
it unreasonably difficult for the College to perform the obligations of the college stated in its catalogue and brochures.
In the event of such cancellation or alteration, the College shall refund all of the money previously collected from
Participant or Parent or Guardian which has not been actually spent or committed to be spent. The allocation of the
refund among Participants will be determined solely at the discretion of the College.

         4. Withdrawal of Participant. In the event the group membership of a student is terminated by the
Participant before departure, the following schedule of fees will apply: a) $300 if termination happens three months
Overseas & Off-Campus Programs
Lewis & Clark College                         Phone: 503-768-7295                                Release and
MSC 11                                        Fax: 503-768-7300                                   Agreement
0615 S.W. Palatine Hill Road                  Email: overseas@lclark.edu                     2010-2011 Programs
Portland, OR 97219                            www.lclark.edu/~overseas                                 Page 16 of 16


or more before group departure (the non-refundable deposit), plus airfare if a nonrefundable ticket has been
purchased in the student’s name (the ticket will be turned over to the student); b) $3,000 if termination happens less
than three months before departure (includes non-refundable deposit) plus airfare if a nonrefundable ticket has been
purchased in the student’s name (the ticket will be turned over to the student). In the event Participant voluntarily
withdraws from the program after departure for the program site, the following fees and charges will apply: a) if the
withdrawal is during the first month of the program the participant will be responsible for one-half (50%) of the
comprehensive fee; and b) if the withdrawal is after the first month of the program the participant will be responsible
for the entire (100%) of the comprehensive fee. College reserves the right to add any fees incurred by Participant to
Participant’s student account, and to refuse registration, provision of transcripts and issuance of degrees until all fees
are paid in full.

           5. Rules of Conduct. 5.1 In addition to Participant’s usual responsibility to the College to comply with its
rules and regulations, Participant must assume added responsibility to the group and to comply with the laws and
customs of the country in question. The College reserves the right to terminate participation of a Participant in the
program, either before or after going abroad, for any of the following causes: a) failure to prepare conscientiously for
the program, including irregular attendance at orientation sessions, inadequate study of assigned materials, and
unsuccessful completion of program prerequisites; b) being placed on academic warning or probation; c) failure to
perform at a satisfactory academic level during the program; d) possession or use of narcotics or hallucinogenic
drugs; e) intemperate or illegal use of alcoholic drinks or public intoxication, or f) participation in black market
activities.

         5.2 In the event the membership of Participant is terminated by the College for any of the foregoing reasons
before going abroad, the first $300 will be automatically forfeited and the College reserves the right to withhold, from
any additional fees paid, an amount, to be determined solely by the College, sufficient to reimburse it for any
expenditures it has already made or will be compelled to make on the Participant’s behalf. In the event the Participant
is terminated by the College after going abroad for any of the aforementioned reasons, the College normally will not
refund any part of the fee. Any refund for compassionate reasons will be solely at the discretion of the College.

          5.3 The College is not able to assist students who break the law in a foreign country and is not responsible
for legal fees or other costs while attempting to secure the release of Participant from foreign custody. Lewis & Clark
students are subject to the law of their host country and community. Neither the Overseas & Off-Campus Programs
Office nor the US Government has the ability to protect Participant from punishment with respect to drugs or other
criminal offenses.

         6. Severability. If any word(s), phrase(s), or term(s) of this agreement are declared unenforceable by any
court of competent jurisdiction for any reason, the remaining word(s), phrase(s), or term(s) shall be valid and
enforceable and construed as if the invalid or unenforceable word(s), phrase(s), or term(s) were deleted.


Signature of Participant                                                   Date


Signature of Parent or Guardian (If Participant is under 21)               Date

NOTE: Applicant and Parent or Guardian must sign and return the original with the application; this form CANNOT
be accepted as a fax or copy. It is highly recommended that the applicant and Parent or Guardian keep copies for
their files.