J-Term 2016 Study Away Application
Wang Center for
Global Education
J-TERM 2016 STUDY AWAY APPLICATION
A complete application must include the following and be submitted to the Wang Center by April 20, 2015:
Typed and signed application form
1 faculty recommendation
Short essay
Copy of signed passport ID page (this may be submitted later if currently applying for a passport)
Application fee
PROGRAM
1st Choice Program Location(s): Faculty Leader Name(s):
2nd Choice Program Location(s): Faculty Leader Name(s):
Please note: a 2nd choice is recommended, but not required.
PERSONAL INFORMATION
Full Legal Name:
Last First Middle
PLU ID Number: Sex: Male Female
Date of Birth:Phone (Cell):
(Day/Month/Year) example: 4/JUL/1996
E-mail (PLU): E-mail (Secondary):
ACADEMIC INFORMATION
College standing at program start date: First Year Sophomore Junior Senior
Major(s):Minor(s):
Cumulative GPA: Academic/Faculty Advisor:
Are you planning to study away or otherwise be away from campus during Fall 2015? Yes No
List all PLU J-Term or semester off-campus courses or programs you have participated in and name the faculty leader(s):
List any previous travel experiences you have had within or outside the U.S. of 10 days or longer duration:
ESSAY
On a separate sheet of paper (typed), address the following items fully; address both writing prompts in at least one well-written double-spaced page:
- Please describe the relationship between your proposed off-campus study program and your academic pursuit at Pacific Lutheran University. Identify several learning goals for your off-campus study and discuss how the program of study or location you have chosen will help you achieve these goals.
- Given that study away can be unpredictable and challenging, which of your personality traits, characteristics and/or skills will help contribute to your success? Which might create challenges for you?
PASSPORT INFORMATION
For international program destinations only.If you do not have a VALID passport, apply for one - or renew - now.
Do you have a valid passport? Yes No
NOTE: Federal regulations require that your passport be valid at least 6 months beyond your return date from abroad.
Please attach a copy of your current passport (photo page only, with signature). If you do not have a passport, upon acceptance to the program, you will need to provide a copy to the Wang Center.
CLEARANCE FOR OFF-CAMPUS STUDYAUTHORIZATION OF RESPONSIBILITY
All students applying for an off-campus course must be in good standing and remain in good standing before and during program participation. Good standing means that you are able to receive academic, student conduct, and financial clearances from the university. Students are also required to obtain a medical assessment and mental health assessment as applicable, to participate in a study away program.
I verify that I am a student in good standing, as described above. I also acknowledge that the information I have provided on this application is true and complete.
Student Signature ______Date______
Typed Name
RECOMMENDATION & WAIVER
One faculty recommendation* is required as part of your application.
*If you have participated in a PLU J-Term study away program, please request a faculty reference from the course leader with whom you traveled. The faculty leader(s) of the J-Term program to which you are applying are not permitted to write a recommendation on your behalf. An exception is for students applying to language programs. Language program applicants are permitted to have a recommendation from the course leader, but must have the recommendation supplemented with a second letter of recommendation from another faculty member. First-Year and Transfer students who have not completed any coursework at PLU may ask a high school teacher, instructor from another college/university, or PLU Admission Counselor to complete the faculty recommendation form.
To whom have you given the recommendation to complete? Your signature is required to authorize the party listed below to provide a recommendation on your behalf.
1)Name/Position/Department:
Under the provision of the Family Education Rights and Privacy Act of 1974, I waive my right of access to this recommendation and understand that the information provided will be used only for the purpose for which it was prepared.
I hereby authorize the above individuals to complete the Faculty Recommendation for Off-Campus Programs form.
Student Signature______Date______
APPLICATION REVIEW & SELECTION
Please note that off-campus programs are competitive. After the April 20, 2015 application deadline, the Faculty Leader(s) and the Wang Center will review all applications and notify you of your application status via your PLU student email address no later than May 8, 2015.A $300.00 non-refundable program payment is due within 2 weeks of acceptance notification.
Revised February 2015
FACULTY RECOMMENDATION FOR OFF-CAMPUS PROGRAMS: J-TERM 2016
A. To the Applicant:
Applicant name (please type)Program Location(s)Course Number
Your signature is required to authorize the professor listed below to provide a recommendation on your behalf. After completing Section A, give this form to a professor who knows you well. Your professor will forward the completed form to the Wang Center for Global Education.
I hereby authorize to complete this form.
Type Professor’s Name
Under the provision of the Family Education Rights and Privacy Act of 1974, I waive my right of access to this recommendation and understand that the information provided will be used only for the purpose for which it was prepared.
Student signature*
*To send this recommendation form to a professoras an email attachment, please type “original signature on application form” in the space above.
B. To Faculty:
The individual named above has applied for an off-campus program. We would appreciate your assessment of this individual’s intellectual ability and motivation, past performance, maturity, and his or her potential for successfully adjusting to life and study in a foreign country (or other off-campus study site). Your assessment will be reviewed by the course faculty leader(s) and/or a Wang Center representative and is a very important part of the application process. Should you desire to discuss this individual’s candidacy with the faculty leader(s)/Wang Center, please indicate with an “X”on the last page of this form, sign, date and submit to the Wang Center.
How long have you known the applicant and in what capacity?
Would you be comfortable traveling with this student?
Academic Ability
ExcellentGoodAverage Below AverageUnknown
Ability to learn factual information
Applies concepts to new situations
Ability to learn independently
Can assess information based on
different perspectives
Additional comments on academic ability: ______
______
Motivation
ExcellentGoodAverage Below AverageUnknown
Seriousness of purpose
Interest in other cultures
Intellectual curiosity
Additional comments on motivation: ______
______
Responsibility
ExcellentGoodAverage Below AverageUnknown
Carries work to completion
Uses good judgment
Reaction to stress
Ability to work without supervision
Takes direction well
Additional comments on responsibility: ______
______
Relating to Others
ExcellentGoodAverage Below AverageUnknown
Sensitivity to diversity
Caring, kind and friendly
Works well with others
Adjusts well to new situations
Additional comments on relating to others: ______
______
How do you recommend this student?_____ Without reservation _____ With Reservation _____ Not Recommended
Among all students you have taught, how would you rate this applicant on a combined measure of academic performance and personal promise?
_____ Top 10% _____ Upper 25% _____ Upper 50% _____ Lower 50%
Your honest assessment of this student and any comments are extremely important to the application review process. Please feel free to add any other information or opinions that you feel would be useful or important to know about the applicant.
______
______
______
Name (please print)
SignatureDate
Position or TitleDepartment
Please contact me regarding this recommendation.
Upon completion, please forward to the Wang Center for Global Education by April 20, 2015
Pacific Lutheran University