WCCCSA Preliminary Study Abroad Application

Study Abroad

Preliminary Application Form
To complete this preliminary application, you will need to:
- Upload your unofficial transcripts
- Upload an essay
- Provide the names and email addresses of 2 people who will send letters of recommendation (at least one should be academic, ideally from a faculty member at your home campus, if you have questions about this pleas reach out to your study abroad campus coordinator).
Essay Requirements: Your essay should be double spaced. The length should be from 700 - 1000 words and address all four questions listed below.
1. What do you hope to accomplish while studying abroad?
2. How does your study abroad program relate to your academic and future professional goals?
3. What you think the biggest challenges will be for you to live in a new country and culture for 1-3 months?
4. What obstacles, financial or otherwise, have you faced in your decision to study abroad?
Instructions:
- If you need any support with this process, please contact your study abroad campus coordinator.
- This is a preliminary application form. Submission of this form does not guarantee admission to a study abroad program, and additional steps will be required.
- If you need access to a physical or pdf form, please contact your study abroad campus coordinator.
- If you are under 18, please consult your study abroad campus coordinator before completing this form.
- You may save your work and come back to it later if you cannot complete the application in one sitting. Select "save" and you will be sent an email link that will allow you to come back to work on the form.
- Your study abroad campus coordinator will contact you shortly after the submission of this form.
- You may be required to attend a study abroad meeting after submitting this form, especially if you have not had a study abroad appointment with our office before.
- As part of the study abroad process, you will need to secure a travel document for the country or countries you visit. The documents required can vary based on your country of citizenship. If you have questions about travel documents, contact your study abroad campus coordinator.
NEXT STEPS AND HOW YOUR APPLICATION WILL BE EVALUATED:
- This is a preliminary application. You will hear from your campus coordinator regarding next steps for final approval for study abroad.
- We will use your essay, transcripts, academic records, letters of recommendation, and any disciplinary records to evaluate your aptitude to successfully participate in a study abroad experience.
- We may require an advising meeting or interview to further discuss your application.
Study Abroad Program Location*
Attention: The South Korea Program requires that students enroll and interview for the program via Green River College. Detailed instructions will be sent about the next steps once you submit your application.
Full Legal Name (as it would appear on your passport)*

First (given) NameMiddle NameLast (family) Name
If you do not currently have a passport, you can still apply for this program. Your campus study abroad advisor can help with guidance on this process.
Date of Birth*

MonthDayYear
Students must be at least 17 by the program start date
Today's date

MonthDayYear
Date
Age in years
Parent / Guardian Name (please enter the name of the parent or guardian who will be signing this form)*

First NameLast Name
Parent / Guardian Phone number *
Please enter the phone number by which the parent or guardian who will be signing this form can be reached
Parent / Guardian Email address*
Please provide the email address for the parent or guardian who will be signing this form.
Student Preferred Email*
example@example.com
Student Prefered Phone Number*
Please enter a valid phone number.
Student Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Is your current address your permanent address?*

yesno
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Identity

* We request the following information to ensure we can fully support all students in their Study Abroad programs and provide appropriate resources. Please note that providing this information is voluntary and will not impact your application in any way. Our aim is to create an inclusive and supportive environment for all individuals participating in our programs.
Gender Identity:
Pronouns:
What's this?
Do you wish to receive information about identity-based resources for Study Abroad? For example, Information for Pell eligible students, Veterans, BIPOC Abroad, LGBTQ+ Abroad, etc.

YesNo
If you answered yes in the previous question, please select the resources you would like to receive:

Pell Eligible studentsVeteransBIPOC AbroadLGTBQ+ AbroadFirst Generation AbroadOther

Do you have an unexpired passport? (A passport is not needed to apply, we ask this question so we know how many participants may need to apply for passports)*

yesnot yet
Country of passport*
When does your passport expire?*

MonthDayYear
Date

Emergency Contact Information
Name of Emergency Contact*

First NameLast Name
Email
example@example.com
Relationship to applicant*
Example: Mother, Father, Brother, etc.

Student Agreement
Participant misconduct

“Participant misconduct” can be defined as any situation in which you jeopardize your own welfare, that of fellow program participants, or of the program; excessive absences from classes or failure to complete course work (if you are participating in the class for credit); abuse of the cultural norms of the community; drug, alcohol, or substance abuse; or violation of the laws of the host country or the regulations governing the host institution; failure to comply with the direction of a college official or employee who is acting in the legitimate performance of their duties, including refusal to properly identify oneself to such a person when requested to do so; conduct which is disorderly, lewd, or obscene, or breach of the peace.

“Participant misconduct” can result in your dismissal from an WCCCSA Member Community College study abroad program. Dismissal from a program, whether voluntary or not, shall not release you from your obligation to make any and all payments of the program fees.
I. As a WCCCSA Member Community College Study Abroad student, my conduct inside and outside the classroom reflects upon the College. As a participant of study abroad, I understand that I am still considered an WCCCSA Member Community College student. I am also expected to abide by the laws and respect the customs of the host country. (Initial below to agree)*
II. I am subject to the Student Code of Conduct (or its equivalent) of WCCCSA Member Community College. I understand that if I violate the Student Code of Conduct, I may be dismissed from the program and lose all academic credit for the program, but will remain responsible for full payment of all program fees. I understand that the Student Code of Conduct is primarily designed for on-campus governance, and therefore, where the Student code of Conduct is silent, or where there is an apparent conflict between it and these Guidelines, I agree to abide by the Guidelines stated here. I may request a copy of the Student Code of Conduct from my college study abroad advisor. (Initial below to agree)*
III. I wish to participate in a study abroad program offered through WCCCSA Member Community College. In exchange for the consideration of my application for admission to the WCCCSA Member Community College study abroad program, I understand and agree to the following:
a. I am responsible for timely payment of all program fees and understand that an academic “hold” may be placed on my college records unless and until I make all required payments that are due to my college. (Initial below to agree)*
b. I am responsible for the completion of all academic requirements of my program, including, but not limited to, classroom work, assignments, projects, field trips, and various assessment and evaluation processes. (Initial below to agree)*
c. I may not manufacture, purchase, possess, and/or use any illegal or unauthorized substance for the duration of the WCCCSA Member Community College study abroad program, including my free time. I understand that the purchase or possession of illegal substances jeopardizes myself, other program participants, and the program itself. I understand that neither the program, nor WCCCSA Member Community College, nor the US Embassy, can obtain my release from custody of local law enforcement authorities. I understand that the violation of this rule of conduct may result in immediate dismissal from the program and the loss of all academic credit for the program. I further understand that I would remain responsible for the full payment of all program fees as well as the cost of a one-way plane ticket from the program destination back home. (Initial below to agree)*
d. I am responsible for informing, in writing, the program representatives of any plans to travel away from my living accommodations before, during, and after the period of the program. I understand that WCCCSA Member Community College, its staff, agents, and representatives are not responsible in any way for any non-program sponsored travel. (Initial below to agree)*
e. I am responsible for providing to my program coordinator a medical form prior to the program departure. All information on this form is confidential and will not be released except as authorized by the participant (see separate Medical Treatment Release Authorization Form). You are not required to report any medical conditions you do not feel comfortable sharing. However, the information you do report will help us better support your health and safety needs while travelling abroad. (Initial below to agree)*
f. I am responsible for requesting reasonable accommodations related to a documented disability in a reasonable time frame prior to my departure from the USA. I understand that my requested accommodations may not be available at the overseas site, but that every reasonable effort will be made to provide alternative reasonable accommodations whenever possible. (Initial below to agree)*
g. I understand that if I do not make my need for reasonable accommodations known in writing to WCCCSA Member Community College in a timely manner, the WCCCSA may delay my participation in the program until reasonable accommodations can be made on my behalf. (Initial below to agree)*
h. In consideration of the opportunity to participate, I release WCCCSA Member Community College, its staff, agents, or representatives from any liability for damage to or loss of property, injury, illness, or death, due to the theft and other crimes committed by persons other than employees or agents of WCCCSA Member Community College, political unrest, use of various modes of transportation, or other activities arising on the part of other program participants, host family members, agencies and organizations, persons, or groups with which WCCCSA Member Community College contracts or recommends for the provision of program services. This release does not apply to intentional, willful, or wanton acts of employees or agents. (Initial below to agree)*
i. Re-entry Protocol Terms: I understand that after my return to the United States and my college campus, I may need to complete a re-entry advising session with the study abroad adviser, and/or complete a survey to help assess each aspect of my program. I further understand that if I received a scholarship that stipulated a follow-on project, I will work with my study abroad advisor to fulfill the terms of my scholarship project. (Initial below to agree)*
j. WCCCSA requires all study abroad participants to abide by the COVID-19 regulations of the host destination country and/or local program providers. These regulations may include testing, vaccination, physical distancing, wearing a mask, quarantine/isolation, and other related safety measures, which are subject to change at any time. I agree that if selected to participate in a WCCCSA Study Abroad program, I will abide by all such regulations and I may be required to sign a COVID-19 Behavioral Commitment outlining what is expected of me before traveling. (Initial below to agree)*
k. I consent to each and every use by the Washington State Community College Consortium for Study Abroad (WCCCSA), and its officers, employees, and agents of: • each photograph, video or other likeness of me taken/recorded on or after the date of my admission to the program • comments provided in interviews. Such uses may include, but are not limited to, publication, newspaper, advertisement, web site, video or other publication or recording. I waive any right to compensation for such uses, or to inspect or approve the uses beforehand. I release WCCCSA, its legal representatives and all persons acting under its permission or authority, from any liability for any blurring, distortion, alteration, optical illusion, or use in composite form that may occur or be produced, as well as any publication or other uses thereof. (Initial below to consent) *Optional.

TERMS OF THE STUDY ABROAD PROCESS

Carefully read the following. By signing and submitting this form you (or the parent / legal guardian of the participant) are agreeing to the terms of acceptance.

Acceptance Terms

1. I understand that if I am accepted to the study abroad program, I will then be required to submit required documents to secure my enrollment, that could include but are not limited to:
- Medical Evaluation Form to determine health conditions that can affect travel
- Medical Release Form to allow medical assistance in an emergency situation if emergency contacts cannot be reached
- Disability Accommodation Form
- Release of Information to allow your basic information to be shared with the program provider and vendors to make arrangements for the program.
- Photo/Video and Media Releases to utilize your images in future marketing, or to opt out of your image use
- Re-Entry Agreements such as a re-entry orientation or advising appointment, without creating an undue burden to alumni schedules
- Passport Scan
- Travel Plans Form, such as airline and flight information to/from the program site.
2. I agree to attend the mandatory pre-departure orientation(s) if I am admitted to this study abroad program.

3. I further certify that I am in good academic and disciplinary standing at my home institution, and that I am not subject to any action at law or facing any pending legal action that would preclude me from departing or re-entering the USA.

4. I also understand that I may need to obtain a visa to attend this program, and that although the study abroad office can offer general advice, it is my responsibility to complete this in time to attend the program.

Payment Terms

1. Program Fee

After being accepted to participate in the Program, and upon confirming my participation in the Program, I will pay a program fee on a date provided, which may include an initial deposit, one full payment, or split payments.

2. Additional Fees

I will pay tuition to my institution, and there may be associated fees based on my home college, program, or tuition setup. In addition, I understand that certain courses at WCCCSA Member Colleges require students to pay special class fees and certain departments may charge students an additional fee in order to maintain enrollment in the major.

3. Additional Personal Expenses

I understand that additional expenses NOT included in the program fee are my sole responsibility and are not part of the fees charged to my student account. WCCCSA strongly advises that I inform myself fully of all cancellation and refund policies for any arrangements I make independently (i.e., flights, excursions, etc.) in connection with the Program before making any financial commitments related to these arrangements. WCCCSA assumes no responsibility for any of these independent expenses that I incur in connection with my Program.

4. Paying with Financial Aid or Scholarships

If I am a Financial Aid or Scholarship recipient, I acknowledge that it is my responsibility to arrange for my Financial Aid/Scholarship funds to apply to the fees outlined above. I understand that because of deadlines associated with contractual obligations incurred by WCCCSA related to the Program, it is possible that I may not know how much Financial Aid or Scholarship funding will be available to me for the term of the Program until after the payment deadlines, and I will be responsible for paying all program fees in part or in full before receiving my financial aid funding.

5. Late Payments

I understand that I am expected to pay all fees associated with my participation in the Program by the posted due date(s). Late payments may be subject to late fees, such as a one-time $100 fee. For tuition, students with account holds or outstanding payments may be prohibited from registering for classes in future terms and may be blocked from receiving college services, such as transcripts or diplomas. If I fail to pay all such fees in full, the WCCCSA Member College may refer me to an outside collection agency with late fee assessment (interest) continuing monthly until paid in full.

Withdrawal Terms

1. Notice of withdrawal from the Program must be submitted in writing to the WCCCSA program coordinator or campus coordinator by email, mail, or in person. The date of withdrawal is the regular business day during which my written withdrawal statement is received.

2. WCCCSA DOES NOT guarantee that any portion of the fees owed will be removed or refunded if I withdraw from the Program for any reason. The later I withdraw from the Program, the higher my financial obligation to the Program is likely to be.

3. If the WCCCSA has paid or encumbered funds on my behalf at the time of my withdrawal from the Program, I am not entitled to a refund of those funds unless and until the third party to which the WCCCSA has paid or encumbered such funds reimburses the WCCCSA or releases the WCCCSA from the financial obligation.

4. If I withdraw from the Program for any reason, I understand and agree that the WCCCSA will not be responsible for any personal expenses or losses incurred as a result of Program cancellation (e.g., flights, excursions, etc.).

5. It may take a significant amount of time for the WCCCSA to identify all unrecoverable costs; a refund amount may not be determined for up to a quarter after the withdrawal.

Medical and Compassionate Withdrawals

6. The WCCCSA will process medical and compassionate withdrawal requests only through established WCCCSA Member College procedures. The review and consideration of requests are at WCCCSA’s discretion. No refunds will be generated for any Program-related charges associated with a medical or compassionate withdrawal.

Withdrawing from Classes

7. After withdrawing from the Program, it is my responsibility to withdraw from all courses associated with the Program in order to avoid any tuition charges and/or to prevent failing grade(s) being issued, subject to the terms of the WCCCSA Member College course withdrawal policy.

8. I understand that any request for a tuition refund must be submitted directly to my home campus office in charge of tuition payments, in accordance with established policies.

Financial Aid and Scholarships

9. If I am a Financial Aid or Scholarship recipient, I acknowledge that it is my sole responsibility to contact my home campus office in charge of financial aid and scholarships immediately upon withdrawal from the Program, as withdrawal may affect my Financial Aid package.

10. If I am a Running Start student, I should be in contact with the Running Start office on my respective college campus to understand whether and how much my tuition in the study abroad program will be covered through the Running Start program. I understand that any study abroad program tuition not covered by the Running Start program is my own financial responsibility.

Program Cancellation

1. Each program has a specific cancellation policy. I will read my program cancellation policy and clarify any questions prior to making a financial commitment.

2. If the Program is canceled prior to departure from the USA, the WCCCSA will notify me by email. WCCCSA will make reasonable efforts to work with the program providers to refund recoverable costs, and will inform me if I am eligible to receive a full or partial refund. Depending on the date or circumstances of the cancellation, I may not be eligible for any refunds.

3. It may take a significant amount of time for the WCCCSA to identify all unrecoverable costs; a refund amount may not be determined for up to a quarter after the program cancellation.

Signature

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Parent / Guardian Signature

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Study Abroad

Identity

Emergency Contact Information

Student Agreement