SEAS STUDY ABROAD CLEARANCE FORM - Columbia …



SEAS Study Abroad Clearance Form

Please complete and submit this form to Dr. Régine Lambrech (510 Mudd) to obtain approval for study abroad. Then bring this signed form to the Office of Global Programs in 204 Lewisohn to finalize your study abroad plans.

GENERAL INFORMATION Please print legibly

Name: _____________________________________________ UNI _______________

Campus phone: ________________________________

Major/Concentration/Minor ________________________________________________

Number of credits completed ________________________

Cumulative GPA ________________

(to be eligible for participation in study abroad, students must have at least a 3.0 GPA)

** Transfer students are not eligible for academic semester or full year study abroad if they have transferred more than 45 credits to Columbia from their previous higher education institution.

COURSE OF STUDY

Location_______________________________ Host University _____________________

Semester(s) planning to study abroad: Fall Spring Full Academic Year

CORE REQUIREMENTS Please check the appropriate core requirements. Indicate IP if in progress

Univ. Writing _____

Gateway Lab _____

Lit Hum, CC or Maj. Cult. _____ _____

Art Hum or Music Hum _____

Economics 1105 _____

Professional Course _____

Calculus _____ _____ _____ _____

Physics _____ _____

Chemistry _____ _____

Computer Science (if required) _____

Physical Education _____ _____

For core requirements not completed, please indicate the course and semester in which you plan to complete them:

Course: _____________________________ Semester to be completed:______________________

Course: _____________________________ Semester to be completed: ______________________

Course: _____________________________ Semester to be completed: ______________________

ACADEMIC MAJOR

How many courses have you completed for your major? ____________________

How many major courses remain? ___________________________

Has your SEAS adviser approved your overseas course choices? ______________ If yes, please provide the signed course equivalency form obtained from the Office of Global Initiatives. If no, please consult with your departmental adviser before seeking clearance from the Office of Global Initiatives.

**Please note that while you are not required to take a language course the semester before studying overseas, it is imperative that you have background in the language of the culture you will be studying in. This can be demonstrated by 4 semesters of language courses or a recognized proficiency test in the host language. If you have no language background in your host country’s language and you will be studying in English, you are strongly advised (and most times required by the host institution) to take a Second Language Class while you are overseas.

ACADEMIC AND DISCIPLINARY STANDING

Have you ever been on academic or disciplinary probation? Academic Probation Yes or NO

Disciplinary Probation Yes or NO

If yes to either of the above, please attach an additional sheet to explain the reasons for your probation and your current standing.

SPECIAL NEEDS Please indicate if you have any special requirements

______ Non U.S. Citizen _____ Disability _____ Accommodation

______ Dietary Needs _____ Religious Needs _____ Medical Needs/On Medication

______ Financial Aid

If you have additional comments, please attach a separate sheet to this form.

My signature below indicates that the information provided is correct and that I have taken the appropriate steps to plan out the remaining core, major and elective classes towards fulfilling my degree requirements.

Student Signature _________________________________________________ Date _____________

The information above has been verified and I indicate SEAS’ approval for this student to study abroad.

Director of Global Initiatives Signature ___________________________________ Date ____________

The information above has been verified and I indicate approval for this student to study abroad.

Approval from the Office of Global Programs

OGP Signature ___________________________________________________ Date ____________

4/29/2009

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