Fillable STUDY AWAY APPLICATION (Bennington College)

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STUDY AWAY APPLICATION (Bennington College)

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STUDY AWAY APPLICATION
Instructions: If you wish to participate in an outside program, complete this
application and return it to the Academic Services and Study Away Counselor (Barn
120C) by October 31 for spring programs, April 28 for fall and academic year
programs.
In addition to this application, you must complete your program provider’s application
and their deadlines vary. You may complete their application after meeting with your
faculty advisor and the Academic Services and Study Away Counselor and receiving
support for your program choice.
You are responsible for collecting and mailing all materials to your program. Be sure to
complete a Transcript Request Form and submit it to the Office of
the Registrar. Note processing time can take up to two weeks.
Application Checklist:
❑ Study Away and the Plan: Speak with your faculty advisor as soon as possible to
discuss your proposed study away and determine if a Plan meeting is necessary.
❑ Study Away Essay: Submit a revision/addendum to your Plan essay. Explain your
reasons for studying away, the program you have selected and courses you will
pursue. Explain how this work will support, enhance, or inform your studies.
Attach a copy of this essay.
❑ Leave of Absence Form: Include all contact information. Look online or contact
your study away program for details. Note all communication will be sent to your
Bennington e-mail while you are away.
❑ Proposed Course of Study Form: Complete this form and bring it with you when
you meet with your faculty advisor and Plan committee members.
❑ Declaration of Agreement: Read carefully and sign. Parent/guardian signature
is required for all applicants regardless of age.
❑ Assumption of Risk Form: Read and complete the Study Away Acknowledgement
and Assumption of Risks and Release Agreement. If you are applying to a program
deemed to be “high risk” by the US Dept. of State, you will need to complete the
Travel Waiver to High Risk Countries. Parent/guardian signature is required for
all applicants regardless of age.
❑ Passport: Do you have a passport? Check it. Is it expired or will it expire while
you’re away? Be sure to start the passport application process early! Attach a copy
of the photo page of your passport to your Bennington Study Away
Application. (Not applicable to students studying away in the U.S.).
❑ Emergency Contact Form: Complete the attached Emergency Contact Information
form and submit it with your Bennington Study Away Application.
❑ Consortium Form: If you receive federal financial aid or other transferable funds,
fill out this form and schedule a meeting with Amy Starr in the Financial Aid Office.
❑
Medical Clearance: Visit Student Health Services for a pre-departure health
screening and to discuss your travel health planning and destination specific info.
❑
Pre-Departure Orientation: Attend this session facilitated by the Director of
Learning Beyond Bennington - held in late November and early May.
Provost and Dean’s Office
Study Away Application / Updated: 07/06/2020
STUDY AWAY LEAVE OF ABSENCE
By completing this form, you are requesting a Leave of Absence from the College for the
academic term(s) listed below. In order to have a leave for study away approved, students
must be in Good Academic and Disciplinary Standing and have approval from their faculty
advisor, Plan committee, and the Academic Services and Study Away Counselor. A Study
Away Administrative Fee (SAAF) is charged per term to all students studying away on
outside programs. Please provide us with your mailing address while on leave; otherwise,
mail will be sent to your permanent address on record.
Student’s Full Name:_____________________________________________________
Current term at Bennington (3
rd
, 4
th
, etc.):____________________________________
Email (non-Bennington):______________________________Phone:______________
Are you a U.S. Citizen: ◻ Yes ◻ No
May we release your name and email to potential study abroad participants?
◻ Yes ◻ No
Academic term away (term and year): ___________________________________
Do you receive federal financial aid of the Davis Scholarship?
◻ Yes ◻ No
Permanent (Home) Address Information:
Address: _____________________________________________________________
City: ___________________________ State: _____ Zip: _____________
Telephone: __________________________________________________________
Study Away Program/Provider Information (If Applicable):
Program Name: _______________________________________________________
Address: ____________________________________________________________
Address 2: __________________________________________________________
Telephone: ______________________ Fax: _____________________________
Email: ______________________________________________________________
College or University at which You Intend to Study, if Different from Above:
Institution Name: _____________________________________________________
Address: ____________________________________________________________
Address 2: __________________________________________________________
Telephone: ______________________ Fax: ____________________________
Email: _____________________________________________________________
Student (signature):_______________________________________Date:________
Provost and Dean’s Office
Study Away Application / Updated: 07/06/2020
Emergency Contact Information
I understand that in the case of an emergency, Bennington College officials may notify my
emergency contact(s).
_______________________________________ _________________________
Signature Date
Please provide your information.
Name: ____________________________________ Term Away: ___________________
Program/University: _________________________________________________________
Permanent Address:
_________________________________________________________________________
Cell Phone: _________________________ Home Phone: _________________________
Non-Bennington Email Address:
_________________________________________________________________________
Please provide complete & accurate information for all emergency contacts listed.
If this information changes at any point before or during the program, please
notify Academic Services immediately.
1
st
Emergency Contact:
_________________________________________________________________________
Relationship: __________________________ Home Phone: _______________________
Work Phone: _______________________ Cell Phone: ____________________________
Address (please provide physical address, not
PO Box):
_________________________________________________________________________
_________________________________________________________________________
Email Address:
_________________________________________________________________________
2
nd
Emergency Contact:
_________________________________________________________________________
Relationship: __________________________ Home Phone: _______________________
Work Phone: _______________________ Cell Phone: ____________________________
Address (please provide physical address, not
PO Box):
_________________________________________________________________________
_________________________________________________________________________
Email Address: ____________________________________________________________
Provost and Dean’s Office
Study Away Application / Updated: 07/06/2020
PROPOSED COURSE OF STUDY
Name of Student: _______________________________________________________
Check each box when complete:
❑ Fill in course information about the classes you hope to take while studying away.
Please note that course availability may be limited, so be sure to include alternate
course selections. We know that your course selections may not be finalized until
you’re away. Please be sure to email your final course schedule to your
faculty advisor and the academic services counselor when you have it.
❑ Discuss your potential course selections with your faculty advisor and Plan
committee members.
Transfer credits awarded are determined by equivalent contact hours; 1 credit
at Bennington is awarded for approximately 3 hours of weekly work (including
class contact hours and outside work) over a 15 week term. A normal
course load per term is 16 credits. Please be in touch with the academic
services counselor or the registrar if you are uncertain of how many credits
you will need to register for to receive a full term of Bennington credit.
Course Title Department Language of US
Instruction Credits
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
_____________________________________________________________
Total Credits _________
Provost and Dean’s Office
Study Away Application / Updated: 07/06/2020
DECLARATION OF AGREEMENT
● Studying away is a privilege that is available to students who have demonstrated the
ability to adjust academically and emotionally to college, and who are ready to benefit
from the challenges of off-campus study. In order for students to receive and maintain
approval for study away, they must be in Good Academic and Disciplinary Standing and
have approval from their faculty advisor, Plan committee, and the academic services
and study away counselor.
● Students studying away for one or two consecutive terms must pay a Study Away
Administrative Fee (SAAF) of $600. This fee is billed prior to your term(s) away.
● Students must enroll in the equivalent of 12 Bennington credits (minimum) to maintain
full-time student status while away.
● If students do not enroll in and successfully complete a full-time load of classes while
away, their academic standing may be in jeopardy when they return.
● Upon completion of your term(s) away, have an official transcript sent to the registrar
here:
Bennington College - Office of the Registrar
1 College Drive, Bennington, VT 05201 USA
● Transfer credits awarded are determined by equivalent contact hours. Transfer credit for
work done at foreign institutions may need to be submitted to the Center for Educational
Documentation for their recommendation. Students will be notified upon receipt of their
transcript if a CED evaluation is required.
● Students must earn a grade of full C or above in a course for it to be considered for
transfer credit.
● Bennington College does not transfer grades or grade points from other institutions.
Only credits are transferred.
● An official transcript for work completed away must be sent to the attention of the
Office of the Registrar, no later than February 10 for students studying away in the fall
term and no later than August 1 for students studying away for the spring term.
● Consortium Students (students who are applying federal financial aid to the cost of their
program) understand that eligibility for financial aid cannot be determined until an
official transcript is received and evaluated. If a transcript does not arrive by the
dates above, a student will not be eligible to receive financial aid for the
coming term.
● Students studying away for a full year must arrange to have a transcript sent to
Bennington after each term/semester by the dates above. If a transcript is not received
by the dates above, financial aid cannot be released for the following term.
● Consortium Students must successfully complete a full-time course load with grades of
full C or above. Failure to do so will impact financial aid eligibility for the coming term.
I, _______________________________ , have read and understand the above.
Student’s signature __________________________________________ Date: __________
I, ________________________________ , have read and understand the above.
Parent’s signature ___________________________________________ Date: __________
Provost and Dean’s Office
Study Away Application / Updated: 07/06/2020
STUDY AWAY ACKNOWLEDGEMENT AND
ASSUMPTION OF RISKS AND RELEASE AGREEMENT
This is a release of legal rights; please review carefully and understand before signing.
Please keep a copy for your records.
Name of Student: _________________________________________________________
Program Abroad: __________________________________________________________
Country: _________________________________ Term/Year Abroad: ________________
In consideration and as a condition of Bennington College approving my participation in the
above study abroad program (the “Program”), I hereby agree to the following:
1. Understanding the Terms of Bennington College’s Approval:
I have read and understand the Study Abroad guidelines outlined in the Bennington College
Study Away Application
.
I also understand that Bennington College’s prior approval of the transfer of credit does not
imply Bennington College’s responsibility for any aspects of the operation of the Program or
university at which I will be studying.
I understand that should I change my Program of study from that listed above, the terms
and conditions of this Agreement still apply.
Matters of academic credit will be evaluated on an individual basis. I understand that if I
am unable to complete the Program due to program cancellation or for any other reason, I
may not receive academic credit for my participation in the Program. I agree that in the
event that I am unable to complete the Program, due to program cancellation or for any
other reason, it is my responsibility to inquire about any possible refund with the Program
manager or sponsor.
2. Medical Circumstances:
Are there any physical or mental health circumstances about which Bennington College
should be aware that may affect your study abroad experience? Yes No (circle one)
If there are any physical or mental health circumstances that may affect my study abroad
experience, I understand and agree that it is in my best interest to discuss the situation
with my physician and with the Program.
In addition, if appropriate I should discuss the situation with the Bennington College
Academic Services person in charge of off-campus study.
3. Risks of Travel and Studying Abroad:
I understand and acknowledge that participation in the Program may involve risks not found
in study at Bennington College’s campus. I understand and acknowledge that these may
include, but are not limited to, risks involved in and from: traveling to and within, and
returning from, one or more foreign countries; different political, legal, social, law
enforcement, and economic conditions; different standards of design, safety and
maintenance of buildings, public places and conveyances; different standards as to the
availability and provision of medical care; and different weather conditions.
I also understand and acknowledge that while participating in the Program and living abroad
I may experience risks and/or differences relating to educational systems, academic
Provost and Dean’s Office
Study Away Application / Updated: 07/06/2020
expectations, recognition of civil rights, lack of accessibility and accommodations for
persons with disabilities, alcohol and drug use, relationships and gender issues.
I have made my own inquiry and investigation into such risks and/or differences, and am
willing to accept them as a condition of my participation in the Program. I acknowledge that
my participation in the Program is wholly voluntary.
I understand and acknowledge that Bennington College does not administer this Program,
and Bennington College does not represent or act as an agent for, and cannot control the
acts or omissions of, any host institution, host family, transportation carrier, place of
lodging, tour organizer or other provider of goods and services in connection with the
Program.
I further understand that Bennington College has not made any investigation into the
health, safety, and security conditions at either the Program site or the countries in which I
will be traveling. Nor has Bennington College investigated the quality or suitability of any
housing or transportation providers that I may use.
4. Release of Liability:
Having examined and understood the above, I, individually, and on behalf of my heirs,
executors, administrators, personal representatives, and assigns, hereby release, acquit,
waive, forever discharge, and covenant not to sue, to the fullest extent permitted by law,
Bennington College, its trustees, directors, officers, faculty, employees, agents, volunteers,
and representatives, from any and all actions, causes of action, suits, claims, damages,
judgments, liabilities, demands, expenses and costs (including attorneys’ fees), or other
losses, of any kind whatsoever, without limitation, which arise out of, result from, occur
during, or are in any way connected, in any manner, with my participation in the Program,
the use of facilities, equipment, or services in association with my participation in the
Program, and/or any related or independent travel or activities, including, but not limited to,
claims for damage to or loss of property, consequential damages, violations of civil rights,
personal illness, injury or death, that I may have or which may hereafter accrue to me.
5. Statement of Indemnification:
I, individually, and on behalf of my heirs, executors, administrators, personal
representatives, and assigns, agree to indemnify, defend, and hold harmless Bennington
College, its trustees, directors, officers, faculty, employees, agents, volunteers, and
representatives, from any and all liability, loss, damage, cost or expense (including
attorneys’ fees) that they or any of them incur or sustain as a result of any actions, causes
of action, suits, claims, judgments or demands, which arise out of, result from, occur
during, or are in any way connected to, in any manner, my acts or omissions during my
participation in the Program, the use of facilities, equipment, or services in association with
my participation in the Program, and/or any related or independent travel or activities.
6. Governing Law & Severability:
I agree that if any portion of this Acknowledgement and Assumption of Risks and Release
Agreement is deemed unenforceable, all other provisions will remain in full force and effect.
I understand and agree that no oral representations or statements by Bennington College or
its representatives will effectively alter the acknowledgements, agreements and
representations stated above. This agreement shall be governed by the laws of the State of
Vermont, which shall be the forum for any lawsuits filed under or incident to this Agreement
or the Program.
7. Agreement:
I HAVE CAREFULLY REVIEWED AND UNDERSTOOD THIS ACKNOWLEDGEMENT AND
ASSUMPTION OF RISKS AND RELEASE AGREEMENT AND I HEREBY AFFIRM MY AGREEMENT
Provost and Dean’s Office
Study Away Application / Updated: 07/06/2020
TO ITS TERMS AS A CONDITION OF MY PARTICIPATION IN THE PROGRAM. I AFFIRM THAT I
AM 18 YEARS OF AGE OR OLDER.
IMPORTANT – READ ENTIRE AGREEMENT BEFORE SIGNING!
Student signature: _________________________________________________________
Date: ______________________________________________________ day/month/year
Name Printed: ____________________________________________________________
Address: _________________________________________________________________
_________________________________________________________________________
Phone: ___________________________________________________________________
Witness: __________________________________________________________________
Witness Name Printed: _____________________________________________________
Address: __________________________________________________________________
_________________________________________________________________________
Both parents or guardians must sign when applicable.
Parent Signature: _____________________
Date: __________________day/month/year
Name Printed: ________________________
Address: ____________________________
____________________________________
Phone: ______________________________
Witness: ____________________________
Witness Name: _______________________
Address: ____________________________
____________________________________
Parent Signature: _____________________
Date: __________________day/month/year
Name Printed: ________________________
Address: ____________________________
____________________________________
Phone: ______________________________
Witness: ____________________________
Witness Name: _______________________
Address: ____________________________
____________________________________
Signatures need not be notarized but must be witnessed.
Provost and Dean’s Office
Study Away Application / Updated: 07/06/2020
STUDY AWAY TRANSCRIPT REQUEST FORM
In order to request a transcript, please complete the following steps:
Complete, sign, and mail this Transcript Request Form to:
Office of the Registrar
Bennington College
One College Drive
Bennington, Vermont 05201
or you may fax the form to 802-440-4876.
Please note:
● Transcripts will not be issued if a financial obligation to the College exists.
● Allow two weeks from date of receipt for the request to be processed.
First name: _________________________ Middle initial: _______ Last name: _______________________
Full name while at Bennington: _____________________________________________________________
Address: _______________________________________________________________________________
City: ______________________________________ State: ______________ Zip: _______________
Telephone: ____________________________ Email: _______________________________________
Weekdays, between 9:00am and 4:30pm
Date of attendance at Bennington: __________________________________________________________
Program of study: □ BA □ MAT □ MATSL □ MFA □ Postbacc
Transcript should be sent: Purpose of Transcript:
□ Now □ Graduate or professional school application
□ To arrive by deadline: _______ □ Employment
□ Hold for end of term grades/evaluations □ Study Abroad
□ Other instructions: ____________________ □ Transfer
_____________________________________ □ Personal use
I hereby authorize the release of my transcript. Please mail #_____ transcript(s) to the address(es)
listed below.
Signature: __________________________________________________ Date: _____________________
Request 1 Request 2
____________________________________ _____________________________________
____________________________________ _____________________________________
____________________________________ _____________________________________
____________________________________ _____________________________________
____________________________________ _____________________________________
Request 3 Request 4
____________________________________ _____________________________________
____________________________________ _____________________________________
____________________________________ _____________________________________
____________________________________ _____________________________________
____________________________________ _____________________________________
Provost and Dean’s Office
Study Away Application / Updated: 07/06/2020
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Completed 22 July 2020

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