ACCENT International Consortium for Academic Programs Abroad

ACCENT International Consortium for Academic Programs Abroad Spring Semester in ROME & PARIS Italy France with Santa Barbara City College Contact ...
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ACCENT International Consortium for Academic Programs Abroad

Spring Semester in

ROME & PARIS Italy France

with Santa Barbara City College

Contact the Santa Barbara City College Study Abroad Office at 805.730.4294 or [email protected]

Program Dates: February 10 - May 10, 2017

February 10 - May 10, 2017 Film and Art in Rome and Paris offers a unique opportunity to explore two of the world’s great capitals through the prism of art and film. The Eternal City of Rome is one of the original centers of cinema and host to the legendary film studios of Cinecittá. During the first half of this semester-length program, students will explore the history of Italian art and cinema while making their own films on the streets of Rome against a backdrop of over two thousand years of art and architecture. After a week-long travel break, students will meet in Paris for the second half of the program. Paris, City of Lights, is the birthplace of the influential French “New Wave” film movement and home to the Cinematheque Français which houses one of the world’s most extensive motion picture archives. Students will continue their studies of European art and view the work of French filmmakers while creating their own films on the boulevards and plazas of Paris. If you have questions about any aspect of this program, please feel free to contact the Santa Barbara City College Study Abroad Office at 805.730.4294 or at [email protected].

Student Services: The ACCENT Centers

ACCENT is an independent study abroad program provider with a multinational team of staff members who all have personal experiences in study abroad. With more than 20 years of experience coordinating high-quality overseas study programs, ACCENT works in partnership with U.S. colleges and universities to develop academically challenging and culturally enriching overseas study experiences in Paris, Florence, London, Madrid, Rome and Istanbul. Each city is home to a fully-staffed ACCENT Study Center that serves as a home base for program participants. The ACCENT San Francisco Center coordinates program enrollment and pre-departure preparation for students, helping to make their transition to living overseas as smooth as possible. The fully-staffed ACCENT Rome and Paris Study Centers serve as a home base to program participants. In Rome the Study Center is located in the historic city center near the Piazza Navona and in Paris the Study Center is located in the historic Bastille district of central Paris. The ACCENT Study Centers are open during the week for students to access the resource and lending library, use the computer lab, ask questions, collect their mail and take advantage of a variety of other student services.

Program Requirements

The Semester in Rome and Paris Program is open to participants who are 18 or older at the time of application. You do not have to be currently enrolled at SBCC, but you must enroll at SBCC for the Spring 2017 semester in order to participate in the Rome and Paris program. By the time of application, you should have completed at least 12 college units with a grade point average of at least 2.5. Furthermore, you should be eligible for English 110. You do not have to be a film studies major and there is no language requirement. Program space is limited. Students who meet the eligibility requirements should send in the attached application with the $250 non-refundable first payment as soon as possible. Upon receipt of your application and first payment, ACCENT and Santa Barbara City College will send you additional enrollment forms. Applications must be received by October 28, 2016. Beyond October 28, limited enrollment is allowed as space permits. For more information, please contact ACCENT at 800.869.9291.

Application Procedure

Deadline for application: October 28, 2016. Apply early as the number of places is limited and as the program is likely to fill before the deadline. Application forms are available at the SBCC Study Abroad Office and online at http://www.sbcc.edu/studyabroad/website/applications.php. You are required to submit a first payment of $250 with your application. An interview with a Tara Stoker will be scheduled upon receipt of your application. If you live outside the Santa Barbara area, you may be interviewed by telephone.

Academic Curriculum

The courses that are offered as part of the program are usually transferable to the University of California and California State University. Check with your counselor for possible exceptions. You must enroll in 14 units. Course

Description

Units

Film Studies 173

Screenwriting I

3

Film Studies 111

Contemporary World Cinema

3

Art History 104

Renaissance to Modern Art

3

Italian 101

Beginning Italian 1

5

Italian 102

Beginning Italian 2

5

Choose one of the following:

Program Orientation

A mandatory pre-departure orientation program will be conducted at SBCC in December, introducing the academic course work, addressing general aspects of study abroad, cross-cultural learning and providing practical information regarding preparation and travel. Please check with the Study Abroad Office for the exact date before you make your travel arrangements.

Program Director

Professor Michael Stinson has been a full-time faculty member in the department of Film and Media Studies at SBCC for the past fifteen years. During that time he has directed five international study abroad programs and taught courses in screenwriting, film production, cinematography, directing, editing, and film history. Professor Stinson was awarded a Master of Fine Arts in Film and Television from U.C.L.A. and worked as a screenwriter for Warner Brothers, Paramount and Universal Studios. He is currently Co-Director of the Student Screenwriting and Filmmaking Competition at the Santa Barbara International Film Festival. Prior to film school, he lived and worked abroad for ten years as a photojournalist based in Rome.

Program Housing

Participants live in double or triple rooms in shared student apartments in a student residence in Rome and shared student apartments located throughout the city in Paris. Exact housing placements will be given to you upon your arrival. Housing is not provided for participants during mid-term break from Monday, April 3 Monday, April 10, 2017.

Program timetable: Application due: October 28

Overseas orientation: February 13

Second payment due: November 1

Classes begin: February 14

Final payment due: December 2

Spring break dates: April 3 - 10*

Pre-departure orientation: Dec. (TBD)

Arrival in Paris: April 10

Departure from U.S.: February 9

National holidays: April 17, May 1

Arrival in Rome: February 10

Return to U.S.: May 10

* Housing is not provided during spring break, participants will be responsible for arranging their own transfer from Rome, Italy to Paris, France, arriving in Paris, France on April 10, 2017. ACCENT will provide all participants a transfer of one piece of luggage (up to 20kg) from Rome, Italy to Paris, France during mid-term break.

Cultural Activities

To acquaint program participants with the cultural aspects of life in Rome and Paris, a series of optional free or inexpensive activities is planned, which varies but often includes lectures on local customs and contemporary issues, sports events, walking tours and dinners. Additionally, there will be the following activities (activities are based on curriculum and are subject to change): • Regular faculty-led walking tours in Rome and Paris • Location scouting and film shoots in Rome and Paris • Weekly group dinners with program director

• • • • • •

Screenings and Q&A with young Italian and French film directors Visit to legendary Italian film studio Cinecittá Film screening at the Cinémathèque Français in Paris Tours of the Coloseum and Roman Forum Visit to the seaside at Ostia Antica One-day excursion to Chartres/Giverny or similar, including coach transport, full-day guide, entries, lunch and entry to Monet’s home

For more information on the SBCC Spring Semester Program, Contact: ACCENT 870 Market Street, Suite 1026 San Francisco, CA 94102 Ph.: (800) 869-9291 FAX: (415) 835-3749

Santa Barbara City College 721 Cliff Drive Santa Barbara, CA 93109 Ph.: (805) 965-0581 FAX: (805) 963-7222

Study Abroad Office Santa Barbara City College Office: IEC 1, Ext. 2494 Tara Stoker [email protected] Office: IEC-2 - 805.730.4294

Program Director Prof. Michael Stinson [email protected] Ph.: (805) 965-0581 ext. 3022 Office: ECOC-1-17

For information about financial aid, scholarships, and travel information, please visit our website: www.sbcc.edu/studyabroad/website

Program Price: $7,250

Payment Schedule

(The price is based on 20 or more program participants. If less than 20 students enroll in the program, the program may be canceled.)

Non-refundable first payment $250 Second payment due November 1 $3,600 Final payment due December 2 $3,600

plus a $200 refundable security deposit

Program Price Includes • Double/triple rooms in shared student apartments in a student residence in Rome and shared student apartments Paris • One-day excursion to Chartres/Giverny or similar, including coach transport, half-day guide and entry to Monet’s home • Pre-departure and overseas orientation program and practical walking tour of areas around the ACCENT Rome and Paris Study Centers • Overseas information and resource center with ACCENT Rome and Paris Study Center on-site staff • Rome and Paris transit pass • Transfer of one piece of luggage (up to 20kg) from Rome, Italy to Paris, France during mid- term break • Arrival transfer from the Rome airport for group flight participants

Program Price Does Not Include • Round-trip airfare (estimated airfare: $1500 - $1700) • Transportation to and from LAX • SBCC Registration fees (see description) • Meals • Required medical insurance • Travel insurance • Personal expenses, books, passports, visas, and anything not listed as included

Transportation

All participants must check-in at the ACCENT  Rome Center February 10, 2017 between 9am and 5pm (Note: most transatlantic flights depart one day before their arrival date). ACCENT will organize an optional round-trip group flight from Los Angeles. Airfare is not included in the program fee. Group flight participants will be met at the airport in Rome and transferred to their housing. Participants on the program will receive detailed optional group flight information approximately four months prior to departure. Estimated airfare $1500 - $1700.

Insurance

It is your responsibility to obtain your own medical insurance. ACCENT requires proof of such insurance. Upon request, ACCENT will supply information concerning health/travel/cancellation insurance options.

(not including airfare)

The above breakdowns include the $200 refundable security deposit. The payment schedule is the applicant's contractual obligation. Failure to make each payment when due shall automatically cancel participant from the program one week after payment due date. All payments are effective the day they are received by the ACCENT San Francisco Center. ACCENT, in its sole discretion, may reinstate an applicant subject to availability of space and late enrollment fees. ACCENT charges a $30 bounced check fee for each check received that is not promptly paid by your bank in the normal course of business.

Payments

After you are accepted to the program, your non-refundable first payment check will be forwarded to ACCENT, travel contractor for the program. Please send the second and final payments to ACCENT directly by the due dates listed on the following payment schedule. Send payments to: ACCENT, 870 Market Street, Suite 1026, San Francisco, CA 94102. Phone: 800.869.9291. If you are accepted to the program after payment dates have passed, you are required to make the past due payment immediately.

Financial Aid

To apply for financial aid, you go to the Federal Student Aid website: www.studentaid.ed.gov to fill out the FAFSA (Free Application for Federal Student Aid) or to the SBCC Financial Aid Office. It may take a minimum of 4-6 weeks to process your paperwork and determine your eligibility for aid. ACCENT offers a Deferred Payment Plan for students receiving financial aid awarded through SBCC. For more information, please contact ACCENT at 800.869.9291.

Registration & SBCC Fees

In the fall we will send you registration materials so that you can register for the program courses online. SBCC fees are not included in the program cost. California residents pay $46 per unit; non-California residents and international students pay $307 per unit. You are required to enroll in 12 units. Fees are subject to change. Though personal spending habits vary widely, we suggest taking at least $1000 per month for food and personal expenses.

Scholarships

If you are eligible for financial aid, you are encouraged to apply for the Benjamin A. Gilman scholarship, which provides awards of up to $5,000 to eligible applicants. Please visit the following website to learn more about the Gilman Scholarship: www. iie.org/gilman The application deadline is October 1. If you would like to apply for an SBCC scholarship, please pick up a scholarship application form in the SBCC Study Abroad Office. The deadline for submission for spring programs is November 1. Awards usually amount to $500 - $1000, and the number of awards varies according to the number of qualified applicants.

Visas

A visa is written permission from the European Consulate to visit or temporarily reside in a country and is granted by the government of that country. The duration of this program is less than 90 days and therefore at the time of this printing U.S. citizens do not require a visa to participate on this program. U.S. citizens are permitted a one-time stay for up to 90 days (within a 6 month period) in the collective countries of the Schengen Territory without a visa. Therefore, if you extend your travel dates beyond the dates of the program or beyond 90 days from the start date of the program, whichever is greater, you are subject to visa requirements. It is your responsibility to assess visa requirements and, if necessary, acquire a visa before your departure. For more information please visit www.eurovisa.info. Note: Non-U.S. citizens may have different visa requirements and should assess their responsibility.

Passports

Specific information about obtaining a passport is available online at: http://travel.state.gov, by calling (877) 487-2778, or in Santa Barbara from the County Clerk-Recorder at 568-2250. Apply for one immediately since passport numbers are needed to make international air reservations 60 days prior to departure and to get an Italian visa. It may take up to twelve weeks to obtain a passport. If you already have one, check its expiration date to make sure it will not expire until at least six months after your return.

Cancellations

If you have to withdraw from the program, you must notify the Study Abroad Office. All cancellations must also be made in writing to ACCENT and are effective the date of receipt by ACCENT. Participants are liable for payments until written cancellation is received.

Cancellation Fees:

70 days or more prior to start of program $250 50 to 69 days prior to start of program $2500 30 to 49 days prior to start of program $3000 15 to 29 days prior to start of program $3500 0 to 14 days prior to start of program No Refund Although the Santa Barbara Community College District has attempted to determine the accuracy of this brochure, the District does not assume any liability with respect to the contents of the brochure. Courses offered, together with other related matters contained herein, are subject to change without notice by the administration and/or Governing Board of the Santa Barbara Community College District for reasons related to enrollment, finances, scheduling, dates, costs or for any other reason, at the discretion of the District. The District further reserves the right to add, amend or repeal any of its rules, regulations, policies and procedures. Travel, housing, meals and other logistical arrangements are provided by a contracting agency not affiliated with Santa Barbara Community College District. Participants will be required to sign a travel request and release which will exonerate the District from any liability. All courses are subject to approval by the Governing Board of Santa Barbara Community College District. All students must enroll for course credit (credit/no credit option available when indicated in the catalog); no auditors are allowed. Units and course grades will be awarded by Santa Barbara City College. ACCENT is not responsible for the academic segment of the program except as specified in the contract between ACCENT and Santa Barbara City College. Nor is ACCENT responsible for airline delays of any kind, or for expenses or loss incurred as a result of such delays. With regard to transportation/travel, regardless of the type of vehicle, ACCENT acts for the passenger as agent only. ACCENT assumes no liability for accident, injury, damage, or loss in any vehicle, or as a result of default by any person or company engaged in transporting the passenger. CST #1013432-40.

Santa Barbara City College Study Abroad Program Application Procedure - Rome & Paris Spring Semester 2017 February 10 - May 10, 2017 (February 9 departure from the US) Deadline for Application: October 28, 2016. Apply early as the number of places in the program is limited and as the program may fill before the deadline. If the program is full before the deadline, acceptance is not guaranteed. Applications may be accepted after the deadline, if space is available. This application is for participation in the Rome and Paris Spring Semester 2017 Study Abroad Program only. To apply to the program, please submit the following: Application form. If you change addresses after submitting your application, please provide the Study Abroad Office with your new address. Unofficial Transcript. Responses to questions (typed or printed clearly). Please answer the questions listed on the back of the application form. Two 2 x 2 photos. Two recent photos that are a full-face view are acceptable. Please trim them to fit. Pictures from a passport service or a photo booth are acceptable. Print your name with a ballpoint pen on the back of each picture and staple the pictures in the box on the application form. Please do not submit copy machine copies of your passport photo. Completed Student Conduct Release Form. The top of this form is to be completed by you and taken to the Dean of Student Discipline at the institution you currently attend. If you currently attend SBCC, please take the form to the Office of Student Support Services in the Student Services Building, Second Floor, Room SS-260. The bottom of the form will be completed by the appropriate school official and returned to the SBCC Study Abroad Office. Your acceptance to the program is not final until the form is returned to the Study Abroad Office. Two completed Recommendation Forms (included in this application). At least one must be completed by an instructor, preferably an SBCC instructor, if you are an SBCC student. The second form may be completed by a person who knows you well such as an employer, supervisor, or long-time family friend. Please no recommendations from relatives, roommates or boy or girl friends. The recommendation forms do not have to be submitted at the same time as your program application. SBCC Enrollment. If you will not be enrolled at SBCC for the Spring 2017 semester, you must complete the SBCC Admissions Application online at www.sbcc.edu/apply/ and enroll for the Spring 2017 semester. $250 non-refundable first payment. Payment may be made by check or money order made out to ACCENT. Please put your check or money order in an envelope and staple it to your application. Submit your application. Applications should include the application form, answers to the questions, photos and your deposit check. Incomplete applications will not hold a space in the program. Recommendation forms and the Student Conduct Release forms may be turned in later provided they arrive at the Study Abroad Office before October 28, 2016. By mail:

Santa Barbara City College or give it to: Study Abroad Office 721 Cliff Drive Santa Barbara, CA 93109

Santa Barbara City College Study Abroad Office International Education Center, Office # 1 (On SBCC East Campus at the end of the upper parking lot)

Interview. After receipt of your application, you will be contacted to arrange an interview with Tara Stoker, Programs Coordinator. For applicants not living in the Santa Barbara area, interviews can be completed by telephone. Notification of Acceptance by SBCC. Carola Smith, SBCC Senior Director of International Programs, will notify you of your acceptance by SBCC to the program after your interview and after a review of your application documents. Communication. The SBCC Study Abroad Office and ACCENT will communicate with you by e-mail and regular mail. We will be using your SBCC PIPELINE e-mail for primary communication. If you change your mailing address or e-mail, please notify the Study Abroad Office immediately by sending your new information to [email protected]. ACCENT

870 Market Street, Suite 1026 San Francisco, CA 94102 Ph.: (800) 869-9291 FAX: (415) 835-3749

Santa Barbara City College 721 Cliff Drive Santa Barbara, CA 93109 Ph.: (805) 965-0581 FAX: (805) 963-7222

Study Abroad Office Santa Barbara City College Office: IEC 1, Ext. 2494 Tara Stoker [email protected] Office: IEC-2 - 805.730.4294

Program Director Prof. Michael Stinson [email protected] Ph.: (805) 965-0581 ext. 3022 Office: ECOC-1-17

Study Abroad Website: www.sbcc.edu/studyabroad/website All statements made on this sheet and distributed generally to prospective or accepted participants shall be for informational purposes only and should not be interpreted as being contractual for any purpose.

1 I currently attend _____________________________________________ 1 I currently attend SBCC. 1 I am an international student.

 1. Staple two 2" x 2" size photo here.

SANTA BARBARA CITY COLLEGE APPLICATION FORM

2. Using a ball point pen, print your name and SBCC-RomPar on the back of the photos.

ROME & PARIS SPRING SEMESTER, 2017 Program dates: February 10 - May 10, 2017

Legal Name ___________________________________________________________ K No. ___ ___ ___ ___ ___ ___ ___ ___ Last First Middle (as it appears in your passport) (Your K number is under the bar code on your SBCC student ID card) Current Address ___________________________________________________________________________________________________ Street Apt. or Box No. City State Zip

Phone (home or cell) (___ ___ ___) - ___ ___ ___ - ___ ___ ___ ___

Work phone (___ ___ ___) - ___ ___ ___ - ___ ___ ___ ___

Address after current semester ends _______________________________________________________________________________________ Street Apt. or Box No. City State Zip

Phone after current semester ends (___ ___ ___) - ___ ___ ___ - ___ ___ ___ ___



Date of Birth ___ ___ - ___ ___ - ___ ___ Participants must be 18 years old on the day of departure.

SBCC Pipeline E-mail address ______________________________ @ __________________________ Please print your e-mail address very clearly. (THIS WILL BE OUR PRIMARY FORM OF COMMUNICATION WITH YOU) Secondary E-mail ______________________________________@_______________________________ Citizenship (country) _____________________ Ethnicity____________________ Academic Major_________________________________ Please indicate the best times to reach you at your current phone: _____________________________________________________________ If you are not currently attending Santa Barbara City College, what school are you attending? ________________________________________ Please list the names of two people who may be contacted in the event of an emergency. These people may be parents, guardians, relatives, or close friends. Name _____________________________________________ __________________________________________ Address ___________________________________________ ___ __________________________________________ City, State, Zip _____________________________________ __________________________________________ Phone ____________________________________________ __________________________________________ Relationship _______________________________________ __________________________________________ I hereby authorize SBCC representatives to contact and discuss with the persons listed above my status in the study abroad program. I further authorize Carola Smith, Senior Director of International Programs, to review my student conduct file. Signature ________________________________________________

Date _____________________________________________

1 I would like to apply for ACCENT’s Deferred Payment Plan. Please send me the Deferred Payment Plan eligibility packet. ACCENT’s Deferred Payment Plan may allow me to defer payment of up to 40% of the ACCENT program fees by using Financial Aid awarded through my school. I understand that if I am accepted into ACCENT’s Deferred Payment Plan, the plan will constitute an amendment to the terms and conditions in this program brochure.

----->

Request for Special Accommodations. If you have a disability for which you will be seeking special accommodations abroad, please contact the SBCC Disabled Students Programs and Services (DSPS) specialist immediately to begin discussions about reasonable accommodations. Phone: (805) 968-0581, ext. 2364. Office: Student Services Building. The process to reach agreement on reasonable accommodations must take place before you leave the US. Students who disclose needs at the last minute or who require accommodations that cannot be made available in the host country, may be advised to postpone participation or consider another program Do you have a medical condition that may prevent you from being able to function in the following or situations or to participate in the following activities? 1 Walking on uneven surfaces for at least two miles 1 Climbing several flights of stairs 1 Sitting in buses/trains/airplanes for extended periods of time 1 Being able to adjust to substantially different diets 1 Being able to function at times in extremely hot or adverse weather conditions If you checked any of the activities listed above, please note your medical condition. The information will be shared with our Health and Wellness Program. If you have questions regarding your health as it relates to your ability to participate in the study abroad program, please consult with your physician. __________________________________________________________________________________________________________ _________________________________________________________________ I have carefully read the brochure for the SBCC Semester in Rome and Paris Program and wish to apply. I agree to the terms and conditions stated in the program brochure, including the payment and refund policies. I understand that if there are any changes in the terms and conditions ACCENT will notify me in writing. I shall be the client of ACCENT for all purposes. Any applicable refunds will be returned to me regardless of the source of payment. Signature _____________________________________________

Date __________________________________________

Required Legal Document Forms If I do not complete and return the required Study Abroad legal document forms by the stated due date, I may be canceled from the program and held responsible for any cancellation penalties, which may apply.  Signature____________________________________________                Date _________________________________________

Responses to Questions. On a separate sheet of paper, please answer the following questions. You may either type or clearly print your responses. Please limit all your answers to all four questions to 1 - 2 pages.

What are 5 things that you are looking forward to about studying abroad? What are 5 challenges that currently worry you the most about going overseas? How do you think the values and perspectives of the host country will be different from your own cultural values? How do you think you will be perceived by the people in the host country based on your nationality and cultural heritage?

Santa Barbara City College Recommendation for Study Abroad Program #1 Please fill out the following recommendation form for _____________________________ who (name of student) is applying to study in Santa Barbara City College’s Rome and Paris Study Abroad Program. Your honest appraisal of this student is appreciated. *** A = excellent

B = good

C = average

D = poor

X = no opportunity to observe

A

B

C

D

X

Academic ability to do college level course work Emotional stability to live abroad Flexibility/openness to new and different experiences Tolerance and openness to cultural differences Sense of personal responsibility Respect for authority and program guidelines Sense of cooperation Consideration of others/works well with groups Other personal characteristics (friendliness, enthusiasm, humor, etc.) Overall evaluation

Comments (optional)

Thank you! Please return to: Study Abroad Office Santa Barbara City College 721 Cliff Drive Santa Barbara, CA 93109

ame: __________________________________________________ N Relationship to applicant: ___________________________________ Phone: __________________________________________________ Date: ___________________________________________________

Santa Barbara City College Recommendation for Study Abroad Program #2 Please fill out the following recommendation form for _____________________________ who (name of student) is applying to study in Santa Barbara City College’s Rome and Paris Study Abroad Program. Your honest appraisal of this student is appreciated. *** A = excellent

B = good

C = average

D = poor

X = no opportunity to observe

A

B

C

D

X

Academic ability to do college level course work Emotional stability to live abroad Flexibility/openness to new and different experiences Tolerance and openness to cultural differences Sense of personal responsibility Respect for authority and program guidelines Sense of cooperation Consideration of others/works well with groups Other personal characteristics (friendliness, enthusiasm, humor, etc.) Overall evaluation

Comments (optional)

Thank you! Please return to: Study Abroad Office Santa Barbara City College 721 Cliff Drive Santa Barbara, CA 93109

ame: __________________________________________________ N Relationship to applicant: ___________________________________ Phone: __________________________________________________ Date: ___________________________________________________

Santa Barbara City College

DEAN OF STUDENTS CONDUCT RELEASE FORM To the SBCC Study Abroad Applicant: 1. Please complete the top part of this form. 2. If you currently attend SBCC, submit this form to Dr. Ben Partee, Dean of Students, in the Student Services Building, Room # SS-260 (second floor). If you currently attend another college or university, give this form and an envelope that has a stamp and is addressed to Santa Barbara City College, Study Abroad, 721 Cliff Drive, Santa Barbara, CA 93109, to the Dean of Students at your school. 3. Ask the Dean to complete the bottom part of the form and return it to the SBCC Study Abroad Office. Name ___________________________________________ Last First Middle

K No. ___ ___

___ ___

___ ___

Address _________________________________________

City, State, Zip ________________________________________

(if you are an SBCC student)

___ ___

Phone number ____________________________________ Dates of Attendance at ________: From ______ to ______

Study Abroad Program location __________________________

I hereby consent to the Dean of the college I am currently attending to furnish Santa Barbara City College with the information on the form below and I hereby waive my right of access to any statements by said Dean evaluating me and my activities. Signature _____________________________________________

Date __________________________________________

To the Dean: The student named above has applied to participate in a study abroad program at Santa Barbara City College. We will be grateful for your comments that will be kept confidential. 1. Has this student been subject to any disciplinary actions? Yes ____ No ____ If yes, please explain. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 2. Are any disciplinary charges pending? Yes ____ No ____ If yes, please explain. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 3. Has this student been expelled, suspended, placed on probation, required to withdraw, or given a reprimand or warning? Yes ____ No ____ If yes, please explain. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 4. Is this student eligible to re-enroll at your college? Yes ____ No ____ Conditionally ___ If yes or conditionally, please explain. ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 5. Any additional comments you may wish to make regarding this student.

________________________________________

____________________________________________________________________________________________________ Thank you for taking time to complete this form and returning it as soon as possible to: Study Abroad Santa Barbara City College 721 Cliff Drive Santa Barbara, CA 93109

Signature ___________________________________________ Name (Please print) ___________________________________ Title ________________________________________________ Institution ____________________________________________ Phone _______________________________________________

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