Kent State University College of Nursing



Kent State University College of Public Health/College of Nursing

Special Topics Course: Summer Intersession

May 16-May 30, 2015

Global Health Immersion

Geneva, Switzerland

Application Procedure:

The trip is open to all majors and priority will be given to Nursing and Public Health students.

To be eligible for application:

Undergraduate students must be in good standing with a minimum cumulative grade point average of 2.75 on 4.0 scale and have successfully completed or satisfied the requirements of PH10001 or NURS10050 by the end of spring semester 2013. This course satisfies the “abroad” requirement in the Global Health Concentration or counts as an upper division elective in any degree. The trip is open to all majors and priority will be given to Nursing and Public Health students.

Graduate students must be in good standing with a minimum cumulative grade point average of 3.0 on 4.0 scale.

Application deadline: November 30, 2014

Notification of acceptance: January 30, 2015

1. Program Application Form. Note: There is a non-refundable application fee of $30.00 payable by check or

money order that is to be made out to Kent State University/OGE. (Office of Global Education). This payment is to be submitted with your application no later than November 30, 2014.

2. Application Summary including outcome objectives. Please submit a one page typed summary including the following information: a) your name, b) GPA, and c) your extracurricular activities including work and volunteer experiences and d) a short summary of your reasons for wanting to take this class and a minimum of three learning outcomes which you hope to achieve.

3. Letters of Recommendation. Two are required. Forms are included in this packet for you to give to faculty. All recommendations must be completed by faculty, supervisors or people who know you well. The completed forms are to be handed in with your application materials in individually sealed envelopes.

4. Additional Photographs. Two official passport photos must be submitted with your application summary and letters of recommendation. The photos must be regular passport type photographs. These are in addition to the two required to get a passport.

5. Agreement/Release Form. Parent or guardian must sign this form if the applicant has not yet reached the age of majority.

Notes:

1. Your passport number and expiration date are required March 15, 2015. If you do not yet have a passport, you will need to apply for one. Passport application forms can be obtained from post offices or AAA. If you are applying for a new passport send your completed passport applications and all required documents to the National Passport Center, P.O. Box 371971, Pittsburgh, PA 15250. For students in this vicinity, the Ravenna Post Office will process your passport application at your request.

2. Medical insurance forms will be sent to you pending your enrollment.

3. Financial information is included for your review. The costs outlined are approximate.

Please return all program application items (including two sealed faculty recommendations) to Grace Battaglia-Hoffman, 126 Lowry Hall for Public Health students and Tracey Motter, 113 Henderson Hall, Room 214.. Mark the large 9 x 11 envelope containing all of your application materials, including your sealed recommendations, with the designation Geneva Intersession Class.

Kent State University College of Public Health/College of Nursing

Special Topics Course: Summer Intersession

May 16-May 30, 2015

Global Health Immersion

Geneva, Switzerland

Please print clearly all information below:

□ Mr. □ Mrs.

□ Ms.

____________________________ _________________________________________ _____

Last Name First Name M.I.

Banner ID Number _____________________ Kent Email Address _________________@kent.edu

Date of Birth _____________ Cumulative GPA ___________ Standing (circle one): FR SO JR SR

Month/day/year

Current College Address: _______________________________________________________________________

Cell Phone: ____________________ Address Valid Through: _____________________

Permanent Address: ___________________________________________________________________________

Home Phone: ____________________

Name of parent/guardian (if under the age of 21) to be notified in the event of an emergency. If over 21, indicate who

you would want contacted in the case of an emergency:

_________________________________ __________________________

Name Relationship

Address: ___________________________________________________________________________________

Phone: ____________________ Alternate Phone: ____________________

Passport Number: ___________________ Issuing Country: __________________ Expiration Date: _____________

Note: Because of increasingly restrictive visa requirements, it may not be possible to admit non-U.S. nationals to this

course. Potential applicants holding non-U.S. citizenship should contact their advisor in the KSU Office of Global Education.

If admitted into the class in Geneva, I agree to accept all conditions of participation as established by the Kent State University Office of Global Education.

I am applying for Intersession Summer 2015.

___________________________________________________ ________________

Signature Date

Kent State University College of Public Health/College of Nursing

Special Topics Course: Summer Intersession 2015

May 16-May 30, 2015

Global Health Immersion

Geneva, Switzerland

Name of Applicant: ________________________________________________________________________

Letter Requested Of: _______________________________________________________________________

Name and Position

Under the Federal Family Education Rights and Privacy Act of 1974, students are entitled to review their records,

including letters of recommendation. You have the option to waive your right to access to these recommendations or

to decline to do so. Please mark the appropriate phrase below indicating your option and sign your name prior to

giving this form to the person completing the recommendation. In the absence of other indications, this

recommendation will be considered confidential.

□ I waive my right to review this recommendation.

□ I do not waive my right to review this recommendation.

__________________________________________________________________________________________

Applicant Signature ________________________________ Date __________________

We ask that students seeking to participate in all foreign study programs of Kent State University submit letters of

recommendation as part of their application procedure. Your comments will be appreciated and most useful to our

selection process. Upon completion of this recommendation, please give the sealed recommendation to the student to include in the student’s application packet.

Students are required to submit application materials together no later than November 30, 2014.

1. How long have you known the applicant and in what capacity?

2. Has the applicant explained to you the program for which he/she is applying?

3. Please mark the statement below that most accurately reflects your opinion about this student's suitability for

this program.

□The student has my strong recommendation.

□ I have minor reservations but am willing to recommend the student and expect him/her to be successful.

□ I consider this student to be a risk but favor acceptance because I believe him/her to be worth the risk.

□ I cannot recommend this student for this program.

4. Based on your familiarity with this student's academic work, will you please give us your opinion about

his/her ability to interact in a foreign environment?

5. If selected, this student may be required to make an adjustment to a challenging situation, quite different from

those to which he/she is accustomed. Please give us your opinion about the student's ability to adapt to

unfamiliar and potentially difficult situations.

6. Will you please comment on this student's ability to relate to other people?

7. Has this student consistently demonstrated on-time attendance and taken total responsibility for his/her actions?

8. Please give an example of a time when the student exhibited a desire to seek new learning/opportunities without faculty initiation.

9. Please make any additional comments you want concerning this applicant's qualifications for this program.

Feel free to attach additional sheets if necessary.

_____________________________________________ _________________

Signature Date

______________________________________________

Title

______________________________________________

Address

Please return this form to the student in a sealed envelope prior to November 30, 2014, so that the student can submit your recommendation with the application packet.

KENT STATE UNIVERSITY

OFFICE OF INTERNATIONAL AFFAIRS

WAIVER OF RESPONSIBILITY

INTRODUCTION. Kent State University's overseas programs are unique opportunities for students to study or travel in foreign countries while earning university credit. The programs rely upon the cooperation and good will of various international organizations, private businesses, foreign governments, and foreign peoples. Because of our obligation to those persons and agencies, and because we understandably cannot assume responsibility for the various common carriers and other agencies which are in different ways connected with our programs, we ask that you adhere to the following terms and conditions of participation. Your dated signature indicates that you understand and agree to those terms and conditions.

AGREEMENT/RELEASE. I, the undersigned, or my parent or guardian if I am a minor, an applicant for participation in an international program of the Office of International Affairs, Kent State University, Kent, Ohio 44242-0001 (hereinafter referred to as the "OGE"), do waive and release the OGE and Kent State University, their employees and agents, my local school or college, any tour organizer or arranger employed or utilized by the OGE from all claims of any nature arising out of events and acts beyond their control (including without limitation Acts of God, strikes, acts of war or terror, weather, sickness, quarantine, government restrictions or regulations) or for any act of omission of any person or entity not controlled by the OGE (including without limitation any airline, bus company, steamship, railroad, taxi service, hotel, dormitory, restaurant, school, university, or other firm, agency, or company). I acknowledge thereby that the OGE, its employees, its agents, its leaders, cooperating U.S. schools and colleges and my local school or college are not responsible for any such events or acts as set forth above without limitation which are beyond their control.

I understand that the air carrier's liability for loss or damage to baggage, or for death or injury to person or property is limited to their tariffs and/or by the Warsaw Convention.

I understand and acknowledge that the OGE and its employees, leaders, and agents have full authority to take whatever actions they may deem warranted to safeguard my health and to ensure my safety. I fully release each of them from any liability for such decisions or actions as may be taken in connection therewith. I authorize the OGE and its agents without limitation to secure medical treatment for me for my welfare at my own (or my parents' or guardians') expense either for such treatment as they may consider to be necessary or in order to otherwise ensure my safety. In the event that the OGE deems my return to the United States necessary or advisable, I hereby authorize it to contact my parents, guardians, or next of kin and to inform them of that decision.

I understand that as a foreign citizen in another country that I am subject to the laws of that country. I agree to conduct myself in a manner that will comply with the regulations of the host country as well as those of Kent State University. I understand that the OGE shall have the right to enforce appropriate standards of conduct and that it shall have full authority to terminate my participation in the OGE program for failure to comply with the OGE's rules, standards, and instructions, including without limitation any action or conduct which the OGE considers to be detrimental to or incompatible with its ideals and goals for international understanding and worldwide peace, and the interest, harmony, and welfare of other students, and that in such case, if OGE deems it best for my welfare or the welfare of the program that I return home, I consent to being sent home at my (or my parents' or guardians') expense with no refund of fees. I will at all times remain under the supervision of the OGE. I agree to indemnify and hold Kent State University, the OGE, its employees, leaders, or agents, harmless for any financial liability or obligation which I personally incur (including without limitation any monies or special expenses the OGE or its agents may advance or loan to me or incur on my behalf while I am abroad), or for any injury or damage to the person or property of others which I cause while participating in the OGE's program.

The OGE is the principal and is responsible to make all arrangements for services and accommodations included in the program in which I participate. I understand that the OGE may cancel programs due to an insufficient number of participants or otherwise, and may alter programs, itineraries, and departure dates, and/or substitute airlines and equipment as OGE may determine in its sole discretion. I understand that the OGE program charges and logistics are based upon currently applicable airline tariffs, ground transportation rates, land costs, and available published information and so depend upon these and other factors over which the OGE has no control, including changes in currency exchange rates, curricula, inflation of other basic costs, or strikes, revolutions, acts of war or terror, or government regulations. Said program charges and logistics therefore are and must be subject to change depending upon the tariffs, regulations, information, rates, and other such significant circumstances in effect at the time of eastbound departure. Program price increases due to such changes in the OGE's basic costs do not constitute grounds for withdrawal with refund.

With respect to the insurance and refund policy obtained and established by the OGE for the protection of its student participants, I understand that unless I file a claim within sixty (60) days after the completion of the academic program in which I participate, the insurer and the principal shall be released from all liability to me or my parents or guardians under the insurance policy or refund policy. In addition, I understand that the OGE is relieved of all liability for items lost in delivery by U.S. mail or otherwise, or not called for by the participant.

I understand that from time to time the OGE's printed and publicity materials may include statements by its student participants and/or their photographs and/or statements of their home university and major field of study; I consent to such use of my comments, photographic likeness, and aforementioned data in such materials.

I have read and completed the OGE Application Form for this program, including this Agreement/Release, and have read the OGE’s applicable brochures, circulars, and memoranda applicable thereto, and understand and agree that the terms and conditions set forth therein are incorporated herein by reference and constitute a part of my agreement with the OGE, including the terms relating to refunds for the OGE program participants appearing in the financial information, refunds section. I further understand that this agreement shall be governed by the laws of the State of Ohio. I certify that I have health and hospitalization insurance which is applicable abroad. I also certify that I am aware of the possible dangers inherent in travel, including the possibility of terrorism, hijacking, kidnapping, or death, and assume any and all risks attendant to the program.

____________________________________________ ____________________

Signature of Applicant Date

I certify that I am the parent or legal guardian of the above minor applicant, that I have read the foregoing agreement/release and all other applicable brochures, circulars, and memoranda, and that I agree fully to be bound thereby.

_______________________________________________ __________________ ____________________

Signature of Parent/Guardian (if student is a minor) Relationship Date

Kent State University College of Public Health/College of Nursing

Special Topics Course: Summer Intersession 2015

May 18-May 29, 2015

Global Health Immersion

Geneva, Switzerland

Financial Information

Academic Year 2014-2015

The financial data indicated here reflects our best current calculations of program costs as of September, 2014, in

accordance with the Fall/Spring Tuition/Fees as confirmed by the Bursar’s Office. We do not anticipate any further

revisions in course tuition, although there are no guarantees that this will be the case.*

Basic Costs Approximate Individual $US Item cost

|Application Fee-non-refundable |30.00 |

|Program Fee-non-refundable |850.00 |

|Overhead, planning, program development, | |

|and general administrative costs | |

|Medical Insurance |22.50 |

|Mandatory group insurance policy specifically designed | |

|for KSU students studying overseas. | |

|Immunizations |

|Students will be required to be in compliance with immunizations per current KSU CON guidelines. This may require some students to update immunizations |

|prior to departure. (out of pocket) |

| | |

|International Transportation (Estimated) |Approx. 1,200.00 |

|Arranged individually | |

|Airfare – Cleveland, Ohio (CLE)-Geneva, Switzerland (GVA) | |

|Housing, Transportation, Admission Fees, Food in Geneva | |

|Housing in KSU Dorm in Geneva (2-3 students/room) |Approx. 1300.00 |

| | |

|Ground transportation (bus or train for sightseeing excursions) fee |150.00 |

| | |

|Sightseeing Admission fees |Approx. 300.00 |

| | |

|Meals |(out of pocket , individually determined) |

|TUITION FEE (Spring 2015) based on Fall 2014 Fee Schedule (Subject to change) | |

|This fee reflects the cost of 3 KSU credit hours, Kent Campus, as of 09/1/14 |Tuition Fee |

|Ohio Residents (Undergraduate) $456/CHR |3 Credit Hours |

|Non-Ohio Residents (Undergraduate) $818/CHR | |

| | |

| |1,368.00 |

| |2,454.00 |

PAYMENT

Because financial commitments must be made for your participation far in advance of your departure and students have withdrawn from International experiences in the past without notice, the following rules regarding payment have been established.

A minimum number of students is required for the class to be offered. However, no fees will be collected until the minimum number of students is assured.

1) Once accepted for the class, a non-refundable program fee $850 is due by February 6, 2015.

2) Course fees (3 hr credit) are due on the deadline dates specified by University. Tuition will be assessed and invoiced at the time of registration. Payment for tuition is due according to the KSU published schedule.

3) Students are expected to pay additional program fees including housing, ground transportation, and sightseeing admission fees by March 6, 2015.

EXTENDED TRAVEL

You may choose to travel around Europe prior to the course or after the course has ended at your own expense. All students are required to arrive at the KSU dorm in Geneva, Switzerland by 3 pm (Local Geneva time) on Saturday, May 16, 2015 and stay until after 7 pm on Friday, May 29, 2015. It is preferred that students make travel arrangements to leave Geneva on Saturday, May 30, 2015.

HONORS COLLEGE CREDIT

Students who wish to take the Global Immersion Course may make arrangements for one additional IHW credit with Assistant Dean Ken Slenkovich directly. Please speak with Assistant Dean Slenkovich regarding fees and requirements involved in the IHW option.

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