E-mail: Cell Phone: Are you a U.S. citizen? If no, country of citizenship: If not a U.S. citizen, are you a permanent U.S. resident? Full Name as Issued on your passport_____________________________________________________
Passport Number: Passport Agency/Authority: Date of Issue: Date of Expiration:
**Your passport must be valid through November 15, 2018—if it will expire before then, you must apply for a new passport by July 1, 2017.**
Current Class Standing: Fr. So. Jr. Sr. Graduation Date:
This is an important part of your application. Take time to answer each question thoughtfully and honestly. Each response should be approximately one paragraph (half page) in length. Attach your type-written answers to this application. Please double-space and number each essay. 1. Why do you want to participate in the Westmont in Cairo Semester?
2. What are you most looking forward to?
3. What challenges do you foresee academically, socially, physically and spiritually?
4. What skills, gifts, knowledge or experience do you bring with you that might contribute to the group and enhance the trip?
ADVISOR’S APPROVAL FOR PARTICIPATION IN THE PROGRAM
Advisor’s Name ________________ Advisor’s signature: Date
RECORDS OFFICE APPROVAL (Applicant: Please take this form to the Records office for completion) ❐Applicant has at least a 2.3 gpa—please circle YES NO
❐ Officially declared major(s) and minor (s) if 59 units will be completed by end of current semester
If you will complete 70 units by the end of the current semester
❐ Requested an Application for Degree for every major and minor you intend to complete. You must return this signed plan to finish your degree requirements to the Records Office prior to your departure abroad.
Signature: Date: STATEMENT OF UNDERSTANDING, PERMISSION FOR RELEASE
OF INFORMATION, AND WITHDRAWAL DEADLINES 1. I certify the information given on this application to be correct and I agree to abide by all the rules, regulations, and requirements of Westmont College and the Off-Campus Programs Department.
2. I understand that my participation in an Off-Campus Program is conditional upon (a) obtaining medical clearance for any current mental or physical health issue, or should a mental or physical health issue arise prior to departure for the program (b) maintaining satisfactory academic (minimum 2.3 cumulate GPA) and student life standing at Westmont College, (c) my application being reviewed and approved by those responsible for selection. It may also be contingent on the availability of appropriate facilities or services at the host institution to provide for any special health conditions I may have.
3. I hereby permit Off-Campus Programs to make the information contained in this set of application papers available to the parties directly involved in my placement in a host institution and to government agencies, such as consulates, for visa purposes.
4. I hereby authorize the registrar to release my academic records to Off-Campus Programs as required.
5. I hereby authorize those parties involved in my admission to an off-campus program to consult with Disability Services and with the Student Life Department regarding my record as a member of the community.
6. I understand that if I wish to restrict disclosure of “directory” information, which is normally released by Off-Campus Programs without student consent, I must notify Off-Campus Programs in writing.
7. I understand that Off-Campus Programs students remain eligible for Westmont financial aid. Financial aid includes, but is not limited to, Title IV Federal Aid programs (with the exception of Federal Work Study) based on the student’s financial need. In addition, I understand that Westmont grants and loans may only be used once for approved programs other than Westmont owned/operated programs..
I understand that I must be cleared with the Business Office and Chaplain’s Office to register for the semester in question in order to participate in this Off-Campus Program as a Westmont student.
I have discussed my participation in this program with my academic advisor and have made the plans necessary to complete all parts of the general education and major program without special accommodation by Westmont College.
I understand that I may not enroll in two programs in consecutive semesters.
I understand that Westmont College will follow the grading policies (e.g. regarding pass/no pass availability, withdrawal deadlines) of the off campus program
I understand that if I end up changing my classes once I arrive at the program, I must contact my advisor and the records office immediately (email@example.com) to receive approval for any changes.
I understand that students enrolling in an off-campus program are subject to all of the same registration deadlines and eligibility requirements as apply for on-campus registration.
I understand that semester-long and Mayterm/summer programs are considered academic credit-bearing programs and therefore ineligible for fundraising efforts with tax benefits. Westmont College or any service projects connected with such academic programs may not be represented as benefiting from any personal solicitation/request for contributions.
Signature of Student: Date:
Please return all forms to the Off-Campus Programs Office no later than March 6, 2017
Westmont in Cairo, Spring 2018
Application deadline: March 6, 2017
For the student to be fairly considered, it is vital that all recommendations be in by the deadline. Applicant: Please fill out this portion and give to reference:
Applicant’s Name: Name of Reference: Title: Circle One:I agree or do not agree to waive my right to access this reference
Applicant’s Signature: Date:
1. How long have you known the applicant?
2. Please indicate how well you know the applicant:
❐Very Well ❐Moderately Well ❐Limited Contact
Please indicate this student’s academic competencies. Comment on areas such as intellectual curiosity, academic motivation, capacity for critical thinking, respect for others with different viewpoints, willingness to assume personal responsibility for own learning:
Please indicate any other factors, which should be taken account of in considering this student’s application (spiritual, social, emotional, physical condition, etc.) Please include any suggestions which would be helpful for our faculty in working with this student:
Your Name: Date: Title: Dept/ Org.: Phone Number:
PLEASE RETURN TO:
Off-Campus Programs Office, Westmont College, 955 La Paz Rd, Santa Barbara, CA 93108. Fax: 805-565-7142.
Westmont in Cairo, Spring 2018
Application deadline: March 6, 2017
For the student to be fairly considered, it is vital that all recommendations be in by the deadline. Applicant: Please fill out this portion and give to reference—someone who knows you well but not a family member or fellow student (However, you may use an RA as a personal reference.) Applicant’s Name: Name of Reference: Title: Circle One: I agree or do not agree to waive my right to access this reference
Applicant’s Signature: Date: 1. How long and in what capacity have you known the applicant?
Please indicate the student’s emotional maturity and adaptability. Comment on areas such as: adaptability to new situations, interpersonal skill, emotional maturity, self-confidence/self-esteem, ability to function as part of a group, skill in self-appraisal, initiative, leadership abilities, capacity for relating to those with differing beliefs or values.