"Summer Study Abroad Application Instructions"
Print Form (Please retain this page for your records – do NOT submit with the application) EXCHANGE PROGRAM APPLICATION INSTRUCTIONS INCOMING STUDENTS GENERAL INSTRUCTIONS 1. The deadline to submit exchange program applications is the last Friday of October for Spring term exchanges and the last Friday in March for Fall term exchanges, unless otherwise indicated. Applicants applying after the stated deadline will be considered at the International Programs Office’s discretion. 2. Applications must be completely filled out and all required supplemental items must be submitted as instructed below for an application to be considered. 3. All exchange applications are to be filled DIRECTLY on this PDF file. Please, NO handwritten applications (except for sections that can’t be typed) as they will not be accepted. After filling out the application completely, print it out and mail it with supporting documentation to: James Cunningham, Director ERAU International Programs Embry-Riddle Aeronautical University 600 S. Clyde Morris Blvd Room SCA 263 Daytona Beach, FL 32114, USA 4. Unless you have an Acrobat Writer, you will not be able to save any changes that you make to your application. Therefore, you must complete the entire application in one session and print it out. Because of this, please make sure you review the application so that you have the required information to completely fill it out. 5. If you have any questions, please contact us at firstname.lastname@example.org. (Please retain this page for your records – do NOT submit with the application) SUPPLEMENTAL ITEMS Please submit all of the following supplemental items with your application to the International Programs Office. To be sent by all academic exchange applicants (non-research students) with the application: 1. Copy of your school’s official transcripts unless you have already supplied it through GE3/GE4. 2. One page (double spaced) essay describing why you would like to study at ERAU and what you expect to get out of your experience. If you are applying through GE3/GE4, you can use the essay required for their application to fulfill ERAU’s requirement. 3. A resume (CV) unless you have already supplied it through GE3/GE4. 4. One passport-sized photo with your application unless you have already supplied it through GE3/GE4. 5. A copy of your passport unless you have already supplied it through GE3/GE4. 6. Affidavit and supporting documentation. Please see the end of this application for the affidavit. Exchange applicants only need to prove funds for living expenses as specified in the affidavit. 7. Insurance documentation. Students must also present all documentation upon arrival to ERAU at the office of International Student Services. Failure to do so may result in automatic enrollment into the mandatory insurance offered at ERAU. To be sent by all research applicants: 1. A resume (CV). 2. A cover letter describing what kind of research you would like to perform and in what field. Please try to describe any relevant past experience you may have. 3. One passport-sized photo with your application. 4. A copy of your passport. To be sent by all visiting professors: 1. A copy of your passport. 2. Letter or document from sponsoring professor/department stating what type of work will be carried out at ERAU (i.e. courses taught, research done, etc.) and financial compensation if any. Note on Housing: If you wish to live on campus, you must apply directly with the Housing department. Please contact Beverly Howell at email@example.com or (386) 323- 8006 for the most recent housing contract and visit our housing website at http://www.erau.edu/db/dorms/index.html for more information about our facilities. After you have filled out an application, you must fax it to (386) 323 8015 and pay the $250 deposit online by going to http://www.erau.edu/db/housing/index.html and click on “Pay Your Housing Deposit Online”. ERAU ID #: _______________ INTERNATIONAL PROGRAMS OFFICE EXCHANGE PROGRAM APPLICATION – INCOMING STUDENTS PROGRAM INFORMATION: Program Type Foreign Institution Term Year Bilateral Exchange Agreement Spring GE 3 Exchange Agreement Fall Dual Degree Fall & Spring Visiting Student Summer Internship/Research/Visiting Professors Please specify the professor supervising your project/work: Last Name: First Name: Middle Name: (As it appears on your passport or birth certificate) Gender: Male Female Date of Birth (mm/dd/yyyy): / / Age During Program: City and Country of Birth: Country of Citizenship: , (City) (Country) Passport Expiration Date (mm/dd/yyyy): Passport Number: / / Level of classes you intend on taking: Main field of study at ERAU: Undergraduate Graduate N/A E-mail: Alternate E-mail: Permanent Address: Mailing Address (if different from permanent): Street: Street: City: State: City: State: Zip Code: Zip Code: Country Country: Telephone number: ( ) Telephone number: ( ) HOME INSTITUTION’S INTERNATIONAL PROGRAMS ADVISOR INFORMATION Name: Phone: ( ) Mailing Address: Fax: ( ) E-mail: PLEASE LIST ANY MEDICAL CONDITIONS THE INTERNATIONAL PROGRAMS OFFICE SHOULD KNOW ABOUT: OTHER COMMENTS OR CONCERNS: IN CASE OF EMERGENCY, PLEASE LIST THE NAMES OF TWO DIFFERENT CONTACTS: Name 1: Name 2: Relationship: Relationship: Telephone number: Telephone number: ( ) ( ) LANGUAGE SKILLS 1. Native Language: 2. Other Languages Spoken: (Please indicate any languages studied and what level of proficiency (Beginner, Intermediate, Advanced, Working Knowledge, Fluent, or Native Speaker) you have acquired) SUPPLEMENTAL INFORMATION FOR FORM DS-2019 Country of legal permanent residence: Occupation in home country: Sponsorship period (mm/dd/yyyy): / / to / / The proposed category of this exchange visitor is: Student Professor Short term scholar Research scholar Specialist Specific field of study, research or professional activity is: If you are currently in the USA, what is your status? (Type of visa) Please include a copy of your I-94 card and appropriate immigration documents (I-20, DS-2019, H- 1B, etc.) FINANCIAL SUPPORT AND DS-2019 In order to issue a Form DS-2019 required to obtain a J-1 visa, ERAU’s International Student Services is required to document proof of financial responsibility for Exchange Visitors. We estimate the average monthly living expenses at $800 - $1200 per month or $9,600 - $14,400 per year. This does not cover the expenses of any dependent(s) who may accompany the Exchange Visitor to the U.S. Exchange visitors may need to show personal funds to cover the expenses of their dependents who will accompany them to the U.S.You must submit one or more of the following documents as proof of support: • An appointment letter in the Exchange Visitor’s name from Embry-Riddle Aeronautical University, a government agency, international organization, or other sponsor. It should specify the length of sponsorship and the amount of money provided (including tuition when appropriate), living expenses, insurance, dependents, books, academic supplies and other personal items. • You may use private or self-sponsorship for the remainder. Embry- Riddle Aeronautical University will require an official bank statement in you or your sponsor’s name and a notarized affidavit of support (found at the end of this application) from personal sponsors, amount of money provided, living expenses, insurance, dependents, books, academic supplies, or other personal items. Please ensure that you provide financial statements accordingly to reflect amounts stated in the Affidavit. Exchange Visitors are required to show proof of health insurance coverage for themselves and each dependent. International Student Services will require proof of coverage upon arrival. Lack of coverage will be seen as a violation of the Exchange Visitor Program regulations subjecting participants to program termination and return to their home country. International Student Services has information on health insurance that provides sufficient coverage. (Please retain this page for your records – do NOT submit with the application) STATEMENT OF STUDENT RESPONSIBILITY The following statement is given to all students studying abroad in Embry-Riddle Aeronautical University sponsored programs. Your signature below indicates your acceptance of the rules and regulations as detailed. Student Conduct In all Embry-Riddle Aeronautical University sponsored programs, students are expected to behave in a mature, responsible manner, and at all times abide by university regulations and the policies embodied in the Embry-Riddle Aeronautical University Student Standards of Conduct. The International Programs Office has the authority to dismiss a student from the program at any time, who is following a course of action or behavior harmful to the student, to others, or to the program, including violation of Embry- Riddle Aeronautical University rules and regulations. In such a case, the student will be asked to leave Embry-Riddle Aeronautical University including program housing and will not be permitted to attend classes. No refunds will be due from Embry-Riddle Aeronautical University, and return transportation costs in such circumstances are the responsibility of individual students. Embry-Riddle Aeronautical University does not condone and strives to prohibit the unlawful possession, use, distribution, or manufacture of illicit drugs and alcohol by students on its property or as part of any of its activities. Specific statements of the university’s polices can be found in the (Student Services CD). Student Liability It is understood and agreed that Embry-Riddle Aeronautical University, cooperating organizations, or individual faculty leaders and directors do not assume liability for any injury, loss, damage, accident, delay, irregularity or additional expense arising from the use of any vehicle or services, or from strikes, weather, quarantines, sickness, government restrictions or regulations, or from any act or omission of any railroad, motor coach, airline, or other transportation company, or for any cause whatsoever. Nor is any responsibility assumed for loss or damage to a participant’s baggage or personal possessions. All such losses or expenses will be borne by the participant. ACCEPTANCE AND RELEASE STATEMENT I understand that I am ultimately responsible for my own behavior during this Exchange Program, and am aware that any unruly and disturbing behavior, or acts in violation of Embry-Riddle Aeronautical University’s (ERAU) Student Standards of Conduct, may be grounds for immediate expulsion from the program. Financial Responsibility. I understand that I am financially responsible for providing my meals, visa fees (if applicable), and any other miscellaneous costs involved in studying abroad. Assumption of Risk. I understand that participating in the Program entails inherent risks in the various activities which I will participate in during this program. I have been given the chance to ask questions concerning the Program. All such questions have been answered to my satisfaction. Having read this form, I am fully aware of the risks and hazards associated with the Program, and hereby elect to voluntarily participate in the Program. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death, that may be sustained by me as a result of participating in the Program, unless it is caused by the gross negligence or willful misconduct of ERAU, its officers, trustees, agents, employees or volunteers (the “Releasees”). (Please retain this page for your records – do NOT submit with the application) Liability Release. In consideration for ERAU allowing me to participate in the Program, I agree I will not sue the Releasees. I release the Releasees from any and all liabilities, claims, demands, actions, causes of actions, costs and expenses of any nature, whatsoever, arising out of any loss, damage, or injury, including death, that may be sustained by me or to any property belonging to me, arising from the Program and its activities or while upon the premises where the Program is being conducted, excepting those claims arising from the gross negligence or willful misconduct of the Releasees. Indemnification. I agree to indemnify and hold harmless the Releasees from and against any loss liability, damage or costs, including court costs and attorneys’ fees, that Releases may incur arising from my involvement in the Program, excepting those claims arising from the gross negligence or willful misconduct of the Releases. Statement of Physical Fitness. I am physically fit and in a condition that will allow me to participate fully in the Program. I maintain medical insurance that covers me for accidents and illnesses while I am participating in this Program. Releasees are relying on my warranty of my physical condition. I understand the Releasees have not made, nor will make, any investigation into my physical fitness or ability to participate in the Program and Releasees are relying on my warranty of my physical condition. I assume full responsibility for payment of medical expenses not covered by insurance incurred as a result of my participation in the Program. Emergency Medical Treatment. I grant the Releasees permission to authorize emergency medical treatment as they deem appropriate, and agree that such action by the Releasees shall be subject to the terms of this Agreement. I understand and agree that the Releasees assume no responsibility for any injury or damage that might arise out of or in connection with such authorized emergency medical treatment. Program Changes. I understand that ERAU reserves the right to make cancellations, changes or substitutions in the Program in cases of emergency or changed conditions, or in the best interest of the group. Should ERAU cancel the program, full refunds, if applicable, will be made unless the cancellation is due to political, natural, technological or other problems beyond its control in which case ERAU will be able to refund only uncommitted and recoverable funds. Insurance. I understand that ERAU requires that all students maintain medical insurance while participating in the Program. The participant shall be financially responsible for any and all medical expenses arising from the Program. In addition, I understand that the payment for medical expenses may have to be advanced by me and reimbursement sought later from the insurance carrier. ERAU also requires that students planning to operate a motor vehicle obtain auto liability and collision insurance that will cover them during their participation in the program. ERAU also recommends that participants obtain personal property insurance to cover losses to personal property while in the Program. Behavioral Expectations. I understand that all students are subject to ERAU regulations and program guidelines and the laws of the host country. In the event I violate any of these, or I sustain academic failure, or I exhibit behavior which is considered by ERAU to be detrimental to myself, other students, or to the Program, ERAU shall have the right to dismiss me from the program while retaining all tuition and fees, when applicable. I understand that I shall be responsible for any extra expense I may incur as a result of this dismissal. It is my express intent that this Agreement shall bind the members of my family and spouse (if any), my estate, heirs, administrators, assigns or personal representatives. I agree that this Agreement and any claim arising from my participation in the Program shall be construed in accordance with the laws of Florida (for Daytona Beach campus students) or Arizona (for Prescott campus students), without regard to its conflict of law provision. The courts in Volusia County, Florida and Yavapai County, Arizona shall be the forums for any lawsuits arising from the Program or incident to this Agreement. The terms of this Agreement shall be severable, such that if a court of competent jurisdiction holds any term to be illegal or unenforceable, the validity of the remaining portions shall not be affected thereby. RELEASE STATEMENT SIGNATURE PAGE (To be printed, completed, and submitted to the ERAU International Programs office) I have read and completed all sections of this application. I have attached the required documentation for my financial status. I declare I have truthfully stated the financial arrangements to support my exchange program at Embry-Riddle University. I understand that the law requires J-1 Exchange Visitors to hold health and accident insurance. I agree to purchase the required insurance for me and my dependent(s) to be effective immediately upon arrival to the U.S. I understand that by not having medical insurance, including repatriation, I will be terminated immediately from the J-1 program. Upon arrival to Embry-Riddle, I will check in with International Student Services and bring my DS-2019, passport and I-94 card. Failure to do this upon arrival can lead to termination from the J-1 program. I acknowledge that certain risks are inherent in the various activities which I will participate in during this program. I understand that my host university and ERAU as well as their faculty and staff have no control over these risks, and are not responsible for my personal welfare beyond ordinary precautions taken for the safety of students. I therefore agree to assume all responsibility for any and all claims for damages including medical expenses, personal injury or death, disability, loss of wages, loss of earning capacity, and property damages which I may incur or may be incurred against me during my participation in this program. In signing this Agreement, I acknowledge that I have read this Acceptance and Release Agreement, including the “Statement of Student Responsibility” and any attachments, understand the terms and information in each, and agree to be bound by their terms. I further acknowledge that I sign this Agreement voluntarily. I have read the above and have willingly signed this document with full understanding of its purpose. ______________________________________________________________________________ Exchange Visitor’s Signature Print Name Date (mm/dd/yyyy) To be completed by exchange visitor’s supervisor at Embry-Riddle (for all categories except student) • I understand that the law requires J-1 exchange visitors and their dependents in the U.S. to hold health and accident insurance. I understand that if the exchange visitor does not purchase insurance effective immediately upon arrival in the U.S., the exchange visitor will be terminated immediately from the J-I program and that the office of International Student Services will notify the Department of State of the termination. • I will make sure the exchange visitor checks in with International Student Services upon arrival at the university. • I will notify the office of International Student Services if the exchange visitor will not be participating in this program or terminates his/her program participation before the scheduled end date. Embry-Riddle supervisor’s signature Print name Date (Please retain this page for your records – do NOT submit with the application) MEDICAL INSURANCE REQUIREMENTS As soon as the exchange visitor arrives in the United States, the exchange visitor and his/her dependents are required by law to have medical insurance with the provisions outlined below. This insurance must be paid in full to cover the exchange visitor and his/her dependents for the duration of his/her Form DS-2019. Exchange visitors have until the Add/Drop period ends for their first term of studies to show their proof of insurance before they are automatically purchased ERAU’s mandatory insurance plan that will be billed to their accounts. Such expense MUST be paid for in order to release any academic transcripts or register the student for future terms. REQUIRED COVERAGE At a minimum, insurance coverage shall include the following basic benefits: Coverage period: the complete time the insured person will be affiliated with the University as an exchange visitor or dependent of an exchange visitor. Medical benefits: at least $50,000 per accident or illness; Deductible: should not exceed $500 per illness or injury; Repatriation: $7,500 (coverage to return remains to home country); Medical Evacuation: $10,000-expenses associated with the medical evacuation of the exchange visitor or dependent to his/her home country. Please complete the attached Health Insurance Certification form and bring it to the Office of International Student Services upon your arrival. EXCHANGE VISITOR PROGRAM HEALTH INSURANCE REQUIREMENT CERTIFICATION FOR J-1 SCHOLARS AND J-2 DEPENDENTS Today’s Date: / / Date of Arrival in U.S.: / / Exchange Visitor: Last Name First Name Middle Initial Telephone#: E-Mail: I (the exchange visitor) certify that I have obtained health insurance for myself (and my dependents), if applicable, during my stay in the Exchange Visitor Program at Embry-Riddle Aeronautical University and that my health insurance meets the minimum requirements outlined below: (a) Insurance which covers the exchange visitor for sickness or accident during the period of time that an exchange visitor participates in the sponsor’s exchange visitor program. Minimum coverage shall provide: (1) Medical benefits of at least $50,000 per accident or illness (2) Repatriation of remains in the amount of $7,500 (3) Expenses associated with the medical evacuation of the exchange visitor to his or her home country in the amount of $10,000 and (4) A deductible not to exceed $500 per accident or illness. (b) An insurance policy secured to fulfill the requirements for this section: (1) May require a waiting period for pre-existing conditions which is reasonable as determined by current industry standards. (2) May include provision for co-insurance under the terms of which the exchange visitor may be required to pay up to 25% of the covered benefits per accident or illness; and (3) Shall not unreasonably exclude coverage for perils inherent to the activities of the exchange program which the exchange visitor participates. (c) Any policy plan or contract secured to fill the above requirements must, at a minimum, be: (1) Underwritten by an insurance corporation having an A.M. Best rating of “A-“or above, an Insurance Solvency International, LTD (ISI) rating of “A-I” or above, a Standard & Poor’s Claims-paying ability rating of “A-“or above, a Weiss Research, Inc. rating of B+ or above, or such other rating as the Department of State may from time to time specify, or (2) Backed by the full faith and credit of the government of the exchange visitor’s home country, or (3) Part of a health benefits program offered on a group basis to employees or enrolled students by a designated sponsor, or (4) Offered through or underwritten by a federally qualified Health Maintenance Organization (HMO) or eligible Competitive Medical Plan (CMP) as determined by the Health Care Financing Administration of the U.S. Department of Health and Human Services. (d) Federal, state or local government agencies, state colleges and universities, and public community colleges may, permitted by law, self-insure any or all of the above-required insurance coverage. (e) At the request of a non-government sponsor of an exchange visitor program, and upon a showing that such sponsor has funds readily available and under its control sufficient to meet the requirements of this section, the Department of State may permit the sponsors to self-insure or to accept full financial responsibility for such requirements. (f) The Department of State in its sole discretion, may condition its approval of self-insurance or the acceptance of full financial responsibility by the non-government sponsor to secure a payment bond in favor of the Department of State guaranteeing the sponsor’s obligations hereunder. (g) An accompanying spouse or dependent of an exchange visitor is required to be covered by insurance in Sec. 514.14 (a) above. Sponsors shall inform exchange visitors of this requirement, in writing, in advance of the exchange visitor’s arrival in the United States. (h) An exchange visitor who willfully fails to maintain the insurance coverage as set forth above while a participant in an exchange visitor program or who makes a material misrepresentation to the sponsor concerning such coverage shall be deemed to be in violation of these regulations and shall be subject to termination as a participant. (i) A sponsor shall terminate an exchange visitor’s participation in its program if the sponsor determines that the exchange visitor or any accompanying spouse or dependent willfully fails to remain in compliance with this section. I hereby certify that I understand and accept that my participation in the Exchange Visitor Program will be terminated if International Student Services determines that I or any accompanying spouse or child of mine in J-2 status willfully fails to remain in compliance with the U. S. Department of State regulations governing required health insurance coverage for Exchange Visitor program participants. Exchange Visitor Signature Date