1. Healthcare

 University of Georgia Study Abroad Program Application
Croatia Maymester Study Abroad 2015
Return complete application by January 30, 2015 deadline to:
Ms. Terri Bradberry
Croatia Maymester Program
University of Georgia
College of Environment & Design
285 South Jackson Street
Athens, Georgia 30602
1. Submit all of the following materials together (except references, see below).
2. Only complete applications will be considered.
Make sure the following items are included in the materials you return:
All pages of the completed and signed application (including this one).
1 copy of your UGA transcript. (obtain from the UGA Registrar's Office)
1 transcript from any other college or university you've attended as a regular degree student, unless
these credits have been transferred to UGA and appear on your UGA transcript.
1 reference form. (It is the applicant's responsibility to secure the reference by the deadline.
The reference may be included in your materials or forwarded by the referee.)
A check or money order for $100 made payable to The University of Georgia. The application fee is
refundable only if you are not accepted into the program
I understand that submitting an application for a study abroad program does not guarantee acceptance into the program. Candidates
must meet program requirements and be approved by the program's faculty. Participation is also subject to availability; the program
may fill up early.
I further understand that the program or individual courses may be cancelled due to low enrollment or other factors and I understand
that I will be informed of such a decision no later than 6 weeks before planned departure date or as soon as possible after any adverse
circumstances that cause the program to be cancelled. I also understand that exchange rate fluctuation and/or inflationary conditions
may necessitate that the program raise fees above the amounts stated between the time of admission and the beginning of the program.
Student Name
Signature
Date
For Study Abroad Program Use Only:
Date Received
Missing Items
Decision
Application Fee Received
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Croatia Maymester Study Abroad Program Application
Personal and Academic Information
Full Legal Name (as
it appears on your passport)
Preferred Name
Birth Date:
Age:
UGA student 810
Sex:
M
F
(Non-UGA students will receive a number on admission.)
Social Security Number _________________________________
Mother/guardian’s Name
Father/guardian’s Name
Spouse’s Name
Are you on the HOPE Scholarship? Yes
No
List any other financial aid you receive, including assistantships
Your college/university
Are you a Georgia Resident? Yes
No
GPA
GPA in major
3rd year
4th year
Master’s
Major(s)
Minor(s)
Academic Level: 1st year
2nd year
Doctorate
Campus Address
Phone
E-mail
(this address will be used by the program to contact you)
Permanent Address
Home Phone
Citizenship
Passport Number
Date of Issuance
Date of Expiration
Please list all colleges or universities previously attended:
Name
Dates: From
Degree(s) awarded
Major
Name
Dates: From
Degree(s) awarded
Major
Name
Dates: From
Degree(s) awarded
Major
2
to
to
to
Personal Activities
Are you currently employed?
yes
no
Occupation
If applicable, give name, address, and phone number of employer:
List the primary co-curricular activities in which you are involved and in what capacity:
Disciplinary and Criminal Record
The University of Georgia’s Office of International Education requires a review of all Study Abroad applicants by the
Office of Student Conduct. If you have questions about your record, you are advised to check with that office before
answering the following questions. Your failure to disclose any disciplinary action is grounds for the denial of
admission to or dismissal from the program.
If the answer to either of the following is yes, you must submit a full statement of relevant facts on a separate sheet
attached to this form.
1. Are you currently, or have you ever been, charged with, or subject to, disciplinary action including
suspension or expulsion for scholastic or any other type of misconduct at any college or university?
yes
no
2. Have you been charged with, convicted of, or pled guilty or nolo contendere to a crime other than a
minor traffic offense, or are any criminal charges now pending against you?
yes
no
Convictions shall include: A finding of guilty by a judge or jury, a plea of guilty, a plea of nolo contendere, a plea
of no contest, an Alford plea to a criminal charge or a plea under the first offender act, irrespective of the
pendency or availability of any appeal or application for collateral relief. If “yes,” explain fully, specifying the
nature of the offense(s), the date(s) it/they occurred, the name and location of the court(s) and sentence(s)
imposed. Please submit court documentation if appropriate.
Course Selections*
You are required to register for 2 courses for a total of 6 credit hours. For planning purposes, please
indicate your preferred course choices below using 1 as your top choice and 3 as the course you are least
likely to enroll in. You may change these during registration.
Undergraduate Level
HPRB 4180: Health Promotion Program
Study Abroad (3 hrs)
HIPR 4070 or LAND 4910: Landscape
Tourism: Emerging Approaches to
Deeper Experiences of Place (3 hrs)
ARTS 4900: Professional Practices: Art
Criticism in Croatian Folk and
Contemporary Art (3 hrs)
Other (with permission of instructor)
Graduate Level
HPRB 7160: Global Health Promotion in
Croatia (3 hrs)
HIPR 6070 or LAND 6910: Landscape
Tourism: Emerging Approaches to Deeper
Experiences of Place (3 hrs)
ARTS 6900: Professional Practices: Art
Criticism in Croatian Folk and Contemporary
Art (3 hrs)
* Courses may be cancelled due to low enrollment
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Essay
Please tell us in 500 words or less why you would like to participate in the Croatia Maymester Study
Abroad program and what you expect to gain from that participation.
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UGA Study Abroad Payment Information
The cost of the Maymester Croatia Study Abroad program is $2,900 plus tuition and fees for six credit hours.
This $2,900 covers lodging during the program, all group transportation*, some meals, most entrance fees,
classroom space, guest lecturers, and cultural experiences. The program is able to offer this discounted program
fee rate thanks to the generosity of the Phillips family.
*Transportation to/from the meeting and ending points in Zagreb, Croatia is not included.
transportation during your free time is optional and not covered by the program.
Additionally,
Students who are not currently enrolled at UGA may be considered for the program if they are accepted as a
UGA transient student. Please contact the program director for an estimate on this additional fee and process.
Program deadlines and payment information:
•
•
•
•
•
•
The application fee of $100 should be submitted along with your completed application, transcript(s)
and reference. A check or money order should be made payable to The University of Georgia.
Program acceptance notices will be emailed to students no later than February 13, 2015.
For accepted students, the program fee deposit of $2,300 is due by February 27, 2015. This should be
a check or money order made payable to The University of Georgia. It should be sent to Terri
Bradberry at the address on the top of this application. If you are admitted into the program after the
initial deadline, the program deposit is due within two weeks of your acceptance into the program.
A final decision on whether the program has sufficient enrollment will be made by March 6, 2015 and
this decision will be communicated by email. This program has had sufficient enrollment every year –
this being the 10th year of the program.
When summer session enrollment opens (usually in early April) students will need to register and pay
for tuition and fees for 6 credit hours.
o UGA tuition is listed on the Bursar’s website: http://www.bursar.uga.edu/tuition.html.
Summer tuition rates are usually not finalized until April each year, however you can look at
prior year rates for an estimate. All students pay only in-state tuition.
o Students enrolled in a study abroad program are responsible for paying the technology fee,
green fee, and institutional fee.
o For some students: $250 Out-of-state Board of Regent’s Fee. This fee is waived for Georgia
residents, whatever home university they attend. It is also waived for students enrolled at
University System of Georgia schools and SEC member institutions, regardless of state of
residence.
o Any graduate students with an assistantship tuition waiver must apply for the Dean’s Award
for International Study upon acceptance into the program.
NEW to all study abroad programs this year. You will be provided with the call number of an
additional non-credit hour course that you will need to register for in Athena during your normal
registration period. The final payment ($500) will be attached to this course and it will be billed to
your student account along with your tuition and fees. DO NOT send a check to the Croatia Program
for this final payment. You need to pay your tuition, fees, and $500 program fee to your student
account at the UGA Bursar’s Office.
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SUMMARY PAYMENT DEADLINES
Description
Application fee
and materials
Program fee
deposit
Register for 6
credit hours of
tuition and fees
Additional
Program fee
Due Date
January 30, 2015
February 27,
2015
Summer
registration
period (usually
April)
Summer
registration
period (usually
April)
Amount
$100
Method
Check to Croatia Program
$2,300
Check to Croatia Program
See the Bursar’s
website
Pay your student account at
the UGA Bursar’s Office
$500
Pay your student account at
the UGA Bursar’s Office
NOTE:
•
•
All program fees, tuition and fees must be paid in full prior to your departure for Croatia.
Please check your UGA e-mail account frequently during the time between acceptance into the
program and your departure.
Refund Information
The Croatia faculty and program staff have a small window of time between the application deadline at the
end of January and the first day of class in mid-May to make the required reservations and payments to
ensure a successful student experience. The program staff negotiate rates with hotels, book particular
modes of transportation, begin wiring funds to Croatia, etc., based on the number of students that we
accept into the program in early February. We depend on the full financial participation of each accepted
student. We acknowledge that in certain situations a withdrawal from the program may be necessary.
The best option for a student seeking to withdraw is to find a replacement student. We have a strict refund
policy in place so that if a student withdraws from the program without a replacement, it does not place a
financial burden on the faculty and other students who are still participating.
•
All requests to withdraw from the program must be made by email to the program director, Hatidza
Mulic at [email protected] with a copy to the UGA Croatia Program email at [email protected] . It is in
the student’s best interest to notify the Croatia study abroad program immediately upon making a
decision to withdraw.
•
If a student is not accepted into the program, the $100 application fee will be refunded. The $100
application fee is non-refundable for students accepted into the program.
•
If a student withdraws from the program on or before February 27, 2015, the student forfeits the
application fee, however additional payments are not required.
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•
If a student withdraws from the program after March 1, 2015 no refund of the $100 application fee
nor the $2,300 deposit will be given. If the exiting student can find a replacement student willing to
assume the program costs, and the program director agrees to the acceptance of this student, it is
possible to receive a refund of the program deposit ($2,300).
•
If a student is dismissed from the program for academic or conduct reasons after the program begins,
or if the student voluntarily withdraws from the program after it has begun, no refunds will be
given. If the program is cancelled due to insufficient student enrollment, then all charges will be
removed and refund provided, as appropriate.
•
If the program is cancelled due to an act of war or terrorism, a State Department warning or other
circumstances that make the program location unsafe, all fees not already spent o r obligated on
behalf of the program will be refunded as appropriate.
•
If a student elects or is unable to participate in one or more individual program activities (field
trips, group meals, etc.), the cost of these activities cannot be refunded.
Student Signature:
I have read and agree to the above policies, amounts, and procedures. I understand and consent to a
check on my disciplinary and criminal record and the release of such information to the Croatia Maymester
program staff. I understand that I am responsible for the payments directly to the UGA Croatia
program and to my UGA student account. In the event my studies abroad program fee balance is not
paid in full by the due date, I agree to pay all collection costs, including attorney fees and other charges
necessary for the collection of any amount not paid when due. Should any payments I make be returned for
insufficient funds, invalid account, etc., I understand these balances will also be treated as stated above.
Signature of Student
Date
Signature of Parent or Guardian (for students under 18)
Date
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