WISE Abroad Signature Page

NOTICE: THIS INFORMATION MUST BE FILLED OUT IN ORDER FOR YOUR APPLICATION TO BE CONSIDERED COMPLETE AT WISE ABROAD. PLEASE OBTAIN THE APPROPRIATE SIGNATURES AS REQUESTED AND RETURN THIS ENTIRE FORM TO OUR OFFICE.

1. EMERGENCY CONSENT AND SIGNATURE:

I hereby give my consent to the program providers of WISE Abroad who serve in (Australia, France, Costa Rica, Dominican Republic, England, Germany, Mexico, Singapore, and Spain) including but not limited to WISE Abroad orientations, Internships, Study Abroad programs, Educate in Taiwan and Costa Rica (TEFL), and Work and Travel USA programs to refer me to appropriate medical staff in case of extreme medical emergency when physically unable to give such consent or when a delay in obtaining such consent could constitute a serious risk of life.

Signature:  ___________________________________________
Date:  _________________

2. STUDENT: TRANSCRIPT RELEASE

I hereby authorize the Australian/French/Costa Rican/Dominican/Mexican/Spanish/Taiwanese/German University or WISE Abroad country director to forward an original transcript or letter of internship completion to WISE Abroad, who will then forward this original transcript or letter of internship completion to my home university Study Abroad/International Programs Office, unless otherwise notified, upon the completion of my semester or program abroad.

Please Print Name Clearly: ________________________________________________

(Student) Signed: ________________________________________________

Date: _____________________

3. TO BE COMPLETED BY STUDY ABROAD ADVISOR / INTERNATIONAL PROGRAMS OFFICER AT YOUR HOME UNIVERSITY

A. Is this student seeking an undergraduate degree at this institution and is considered of good academic standing?     Yes    No

B. Has this student been involved in any serious legal or disciplinary action while attending your institution?   Yes   No 

C. Has this student ever been on academic probation while attending your institution?   Yes    No

D.  Does this student have approval to study abroad at his or her chosen university?   Yes    No

As the study abroad advisor, I understand that upon completing the program, the home university will receive an official sealed transcript or internship completion letter from the Australian/French/Costa Rican/ Dominican/Mexican/Spanish/Taiwanese/ German university or country director.  I understand that a recommended grading scale conversion for these university systems will accompany each record and hereby inform the applicant that we require course descriptions for all transfer credit and credits, and are only transferred if the student earns satisfactory marks which are equivalent to the U.S. grade of ______ or equivalent mark of ____.

1.  The student's home institution will award:
     (Circle one)    Letter grades    Pass/Fail    Transfer Credit    Other

2.  These marks will be calculated in his/her GPA:    Yes   No

Signed:_____________________________________________________
Name:  _____________________________________________________
Title: _______________________________________________________
University Name:  ____________________________________________
Name of Office: ______________________________________________
Address: ___________________________________________________
City: ___________________ State: ______ Zip: _______
Telephone: (     ) ________________ Fax: (      )  __________________
Email: ______________________________________




DECLARATION

I certify that the statements I have made on this application are true and correct and will contact WISE Abroad with any changes or be subject to potential dismissal.

I waive my right of access to any and all information related to my study abroad file at WISE Abroad and authorize the WISE Abroad office to forward copies of these documents to U.S./Overseas institutions and personnel.

I hereby authorize my name, address and telephone to be distributed to other participants.

I understand that the application fee is not refundable under any circumstances.

I agree to abide by the rules and regulations of the foreign university, U.S. sponsoring university or program.

I have read and understand the WISE Abroad enrollment guide for my program.

Signed: _______________________ Date: ____________

BEFORE YOU MAIL THIS FORM, HAVE YOU INCLUDED OR ARRANGED TO HAVE SENT THE FOLLOWING:

  • Application complete with personal statement and email address
  • $30 US non-refundable application fee
  • Official or copy of  transcript(s)
  • Faculty reference
  • One passport size photo (you may also email a personal photo to WISE Abroad)

Please mail your completed application to:

USA Office
WISE Abroad
6464 Willow Broom Trail
Littleton, CO  80125, USA
Tel:
979-492-1345 or 979-776-1387
Email:
wise@wiseabroad.org
Website:
www.wiseabroad.org

If you have any questions about this application,
please call (979) 492-1345 or (979) 492-1375