Student Application Form International Service Learning Program to ...

Student Application FormInternational Service Learning Program to Oaxaca, Mexico, Winter Break 2008-09Application Due: Friday, September 26, 2008 by 5:00P.M.Please return this form and answers to the essay questions to Dr. William Shorr, Longwood 5 Office;Phone: (617) 879-2232; E-mail: wshorr@wheelock.edu by 5:00P.M. on Friday, September 26, 2008.Please be sure to read and sign the back of this application form.Name:(last, first, middle initial)Student ID#:E-mail address:Phone:Address:StreetCity State ZipCitizenship: Do you have a valid passport?  Yes  NoCircle One: Sophomore Junior Senior Graduate StudentFor CoF Students, Please List Home University: _____________________________________________Professional Concentration/Major:The travel cost for this program, in addition to tuition, is $2,300. Will you be requesting financialassistance towards the travel cost? _________ If so, how much? _______________________________A limited amount of assistance may be available to Wheelock College students to help defray travel costs.Program Requirements:All students admitted to the program must participate in a pre-departure session and register for thecorresponding Spring 2009 course, EDU 260 Mexico Learning in Action. Required dates are as follows:Pre-departure sessions:Date TBATravel to Oaxaca, Mexico: December 27, 2008 – January 11, 2009Debriefing Session after Returning to Wheelock: January 28, 2009Please answer the following questions on a separate sheet and return with this application form:1. Why would you like to participate in this International Service Learning trip?2. How will your participation in this program support your personal and professional learninggoals?3. What is your level of experience with the Spanish language?4. Cooperation, collaboration, and appreciation of the diversity and richness of other cultures will beessential on this trip. Please give a concrete example that illustrates your ability to cooperate,collaborate, and appreciate difference.

Terms and ConditionsApplication and DepositsOnly students in good academic, financial, and disciplinary standing are eligible. Students should return thecompleted application form and answers to the four essay questions to Dr. William Shorr, Faculty Leader, on orbefore September 26, 2008. The Faculty Leader will notify the student within one week of receipt of thisapplication if s/he has been approved to participate in the Program. After receiving this approval, students areexpected to submit a $200 deposit made payable by check to Wheelock College, with the student ID number anddestination country clearly printed on the check, within one week. Students will register for the course associatedwith the International Service Learning Program through the Wheelock College Office of Records and Registration.Wait-ListEnrollment for this program is limited and will be closed when filled to capacity. Students will be notified if theyare wait-listed for the course. To accept placement on the wait-list, students must submit the $200 deposit withinone week as described above. If an opening becomes available, the student will be contacted via telephone and E-mail. A wait-listed student will be given 24 hours to reply before being dropped from the list. If a student isdropped from the list, the deposit will be refunded in accordance with the Office of Financial Services policy. If nospace becomes available, all wait-list deposits will be refunded.Tuition and Financial AidUndergraduate students are billed the flat tuition rate charged each semester for 12 to 20 credit hours. Graduatestudents are charged on a per-credit basis. Tuition refunds for International Service Learning Program courses areprocessed in accordance with the Office of Records and Registration’s tuition refund policy. NOTE: Nonattendancein a class does not constitute withdrawal from a course. Students must complete additional paperwork inorder to be eligible for federal and state aid during the period that they are studying off-campus. The additionaltravel cost of the International Service Learning Program may be included in a student’s financial aid package inmost cases; students should consult their Financial Aid counselor for more information.Travel CostThere is a travel cost of $2300 in addition to tuition. This cost includes airfare, airport transfer, housing and mostmeals, entry fees, receptions, cultural activities, and travel insurance. Ability to pay is not a factor in admissiondecisions. The Faculty Leader will assist students with further information about costs and fundraising. The travelcost is due as follows:$200 Deposit due after acceptance – must be submitted by October 7, 2008Payment of $1,050 due on November 1, 2008Final payment of $1,050 due on December 1, 2008Withdrawal from an International Service Learning ProgramTo withdraw from the program, students must complete an official Add-Drop form available in the WheelockCollege Office of Records and Registration, obtain a consent signature from the Faculty Leader, and turn the form into the Wheelock Office of Records and Registration. In the event that a student withdraws, a refund will beprocessed in the following manner: Wheelock will bill students for any charges the college has incurred on thestudent’s behalf, such as airline tickets, plus a $100 administrative fee. Note: This is in addition to the $200 deposit,which becomes non-refundable on October 15, 2008.For Further InformationPlease contact: Dr. William Shorr, Assistant Professor, Elementary Education, E-mail:wshorr@wheelock.edu, Phone: (617) 879-2232.Lauren Thorman, Associate Director, Center for International Education, Leadership, andInnovation, E-mail: lthorman@wheelock.edu, Phone: (617) 879-2447.I have read, understand, and agree to the terms and conditions outlined on this form.Student Signature:Date: