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STUDY AWAY APPLICATION INTERNATIONAL EXCHANGE (Bennington College)

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STUDY AWAY APPLICATION – INTERNATIONAL EXCHANGE
Instructions: If you wish to participate in an international exchange program, complete
this application and return it to the Study Away Office (Barn 120C) by September 15 for
spring programs, April 15 for fall programs.
In addition to this application, you must complete your host school’s application and their
deadlines vary. Students nominated for an exchange will receive instructions on how to
complete these applications.
Exchange Program: Check each program for which you wish to apply.
___ Bath Spa University ___ Quest University
___ Ecole National Superieure d’Arts de Paris Cergy ___ University of East Anglia
___ Kansai Gaidai University ___ University of Hearst
___ Leuphana University ___ Toi Whakaari
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.
❑ Proposed Course of Study Form: Complete this form and bring it with you when you
meet with your faculty advisor and Plan committee members.
❑ Financial Responsibility Agreement: In general, exchange participants pay tuition to
Bennington College and pay housing and fees to their host institution. For a list of
anticipated expenses, please visit here. Each student is responsible for their own
meals, transportation, passport expenses, excess baggage shipment and storage,
independent travel, personal expenses, and books, as well as living expenses during
extended academic recess (i.e. holidays, winter and spring break, etc.).
❑ 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 Abroad Acknowledgement
and Assumption of Risks and Release Agreement. 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.
❑ Student Information and Emergency Contact Forms: Complete the attached forms
and submit them with your 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 designation specific information.
❑
Pre-Departure Orientation: Attend this session facilitated by the Director of Learning
Beyond Bennington - held in late November and early May.
Student Information Form
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?
◻ Yes ◻ No
If you are an international student, do you receive the Davis Scholarship?
◻ Yes ◻ No
Permanent (Home) Address Information:
Address: ________________________________________________________________
City: ______________________________ State: ________ Zip: ______________
Country:_________________________________________________________________
Telephone: ________________________ Email: _____________________________
I understand that in order to be approved for an exchange, students must be in Good
Academic and Disciplinary Standing and have approval from their Faculty Advisor, plan
committee, and the Study Away Counselor.
Student (signature):_______________________________________Date:_____________
Office of the Provost and Dean
International Exchange Application / Updated: 07/07/2020
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 Study Away Counselor when you have it.
❑ Discuss your potential course selections with your Faculty Advisor and Plan committee
members.
❑ Credit conversions vary depending on your host school/country. You should plan to
enroll in the equivalent of 15 Bennington College credits per term.
o Example: 60 Bath Spa/East Anglia UK credits = 15 Bennington College credits
o Example: 30 Leuphana University ECTS credits = 15 Bennington College credits
Course Title Department Language of US
Instruction Credits
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Total Credits __________
Office of the Provost and Dean
International Exchange Application / Updated: 07/07/2020
INTERNATIONAL EXCHANGE
FINANCIAL RESPONSIBILITY AGREEMENT
Exchange participants pay tuition and other mandatory fees to Bennington College. Each
student is responsible paying the costs of housing and meals, international airfare, local
transportation, passport and visa fees, international health and travel insurance, mandatory
vaccinations and immunizations, excess baggage shipment and storage, books and supplies,
personal expenses, as well as living expenses during extended academic recess (i.e.
holidays, winter and spring break, etc.).
Outlined here are approximate expenses for one term of study at each exchange site
that are NOT included.
Please note that this total is an average estimate of costs and is based on the exchange rate
at the time of this application update.
Check each program for which you wish to apply and have reviewed the
approximate expenses that you will be responsible for paying independently.
___ Bath Spa University ___ Quest University
___ Ecole National Superieure d’Arts de Paris Cergy ___ University of East Anglia
___ Kansai Gaidai University ___ University of Hearst
___ Leuphana University ___ Toi Whakaari
By signing below, I acknowledge that I have reviewed the approximate expenses worksheet
online via the link provided above. I understand that if I am selected to participate in the
exchange program, I will be financially responsible for all additional expenses incurred
during my time at the host university and I am prepared to cover these costs.
Student Name: ____________________________________________________________
Signature: _____________________________________________ Date: ____________
Parent Name: _____________________________________________________________
Parent Signature: _______________________________________ Date: ____________
Office of the Provost and Dean
International Exchange Application / Updated: 07/07/2020
INTERNATIONAL EXCHANGE
DECLARATION OF AGREEMENT
● Studying abroad 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 advisor, plan committee, and the Study Away Counselor.
● Students must enroll in the equivalent of 12 Bennington credits (minimum) to maintain
full-time student status while abroad.
● 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
● Transfer credit will be awarded for grades of full ‘C’ or above received on an official
transcript.
● I understand that it is my responsibility to request an official transcript from my host
institution and that an official transcript must be received in order for credits to be
transferred. I understand that a provisional report can be used to verify credits earned
until an official transcript is available.
● An official transcript for work completed abroad must be received by the Office of the
Registrar no later than February 10 for students studying abroad 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
verification of credits completed is received. 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. If a transcript is not received verifying completion
of credits, financial aid cannot be released for the following term.
● Consortium Students must successfully complete a full-time course load with grades of C
or above. Failure to do so will impact financial aid eligibility for the coming term.
I, ________________________________ , have read and understand the above
statements.
Student’s signature ___________________________________________ Date: ________
I, _________________________________ , have read and understand the above
statements.
Parent’s signature ____________________________________________ Date: ________
Office of the Provost and Dean
International Exchange Application / Updated: 07/07/2020
INTERNATIONAL EXCHANGE 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
Office of the Provost and Dean
International Exchange Application / Updated: 07/07/2020
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:
Office of the Provost and Dean
International Exchange Application / Updated: 07/07/2020
I HAVE CAREFULLY REVIEWED AND UNDERSTOOD THIS ACKNOWLEDGEMENT AND
ASSUMPTION OF RISKS AND RELEASE AGREEMENT AND I HEREBY AFFIRM MY AGREEMENT
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 Printed: _________________
Address: ____________________________
____________________________________
Parent Signature: _____________________
Date: __________________day/month/year
Name Printed: ________________________
Address: ____________________________
____________________________________
Phone: ______________________________
Witness: ____________________________
Witness Name Printed: _________________
Address: ____________________________
____________________________________
Signatures need not be notarized but must be witnessed.
Office of the Provost and Dean
International Exchange Application / Updated: 07/07/2020
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: ___________________
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 the Study Away Counselor 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: _____________________________________________________________
Office of the Provost and Dean
International Exchange Application / Updated: 07/07/2020
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
_________________________________________ ______________________________
_________________________________________ ______________________________
_________________________________________ ______________________________
_________________________________________ ______________________________
_________________________________________ ______________________________
Office of the Provost and Dean
International Exchange Application / Updated: 07/07/2020
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STUDY AWAY APPLICATION INTERNATIONAL EXCHANGE (Bennington College)

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Completed 22 July 2020

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