Please complete in full and collect all necessary signatures prior to submission in hard copy to the Office of International Programs. Thank you!

Approval Signatures

Faculty Sponsor of Proposal

Name: Click here to enter text. Title: Click here to enter text. Date: Click here to enter a date.

Approval of Dean of the Sponsoring College
Recommendation: Click here to enter text.

Name: Click here to enter text. Title: Click here to enter text. Date: Click here to enter a date.

School/College: Click here to enter text.

Approval of Academic Department

Name: Click here to enter text. Title: Click here to enter text. Date: Click here to enter a date.

Name: Click here to enter text. Title: Click here to enter text. Date: Click here to enter a date.

Approval of the Office of International Programs

Signature

Jeanne Marion, Coordinator

Date: _________________

1.	Basic Description of Proposed Program

Date of submission: Click here to enter a date.

Program title: Click here to enter text.

Host institution(s) or third-party provider (if any): Click here to enter text.

Country(ies) visited: Click here to enter text. City(ies): Click here to enter text.

Term requested	☐ Allen Term / January

☐ Spring Break

☐ May

☐ Summer – which months? Click here to enter text.

☐ Other

Proposed term of implementation

☐	Spring 20Click here to enter text.
☐	Summer 20Click here to enter text.
☐	Fall 20Click here to enter text.
☐	Winter 20Click here to enter text.

Proposed dates:

Click here to enter text.

Recurrence:

Choose an item.

2.	Target Audience: AU Population(s) Served

Level	☐ Undergraduate credit

☐ Graduate credit available

Scope	☐ Restricted to students from one discipline – please specify: Click here to enter text.

☐ Students from these disciplines may apply – check all that apply:

Accounting

Art (BFA)

Art (Interdisciplinary) (BA)

Art History & Theory

Athletic Training

Biology

Business Administration

Chemistry

Communications Studies

Comparative Cultures

Criminal Justice Studies

Education

Engineering - Biomaterials

Engineering - Ceramic

Engineering - Glass Eng. Sci

Engineering - Mat. Science

Engineering - Mechanical

Engineering - Renew. Energy

Engineering - Undecided

English

Environmental Studies

Finance

Foreign Language & Culture

General Science

Geology

Gerontology

Global Studies

Health and Fitness Mgmt

History

Individually Structured Major

Interdepartmental Major

Marketing

Mathematics (BA)

Mathematics (BS)

Mathematics w Actuarial Sci

Philosophy

Physics

Political Science

Psychology

Sociology

Spanish

Theatre

Undecided

Pre-Professional Advising

Pre-Art Therapy

Pre-Health: Chiropracty

Pre-Health: Dentistry

Pre-Health: Medicine

Pre-Health: Osteopathy

Pre-Health: Other Allied
Health Professions

Pre-Health: Pharmacy

Pre-Health: Physical Therapy

Pre-Health: Physician Asst

Pre-Health: Psychiatry

Pre-Health: Public Health

Pre-Health: Veterinary

Pre-Law

3.	Admission Requirements for AU Students

Minimum class standing requirement (at time of participation) – check one:

☐ First year (second semester only); must have completed 15 semester credits

☐ Sophomore standing required; must have completed 30 semester credits

☐ Junior standing required; must have completed 60 semester credits

☐ Senior standing required; must have completed 90 semester credits

☐ Graduate standing required

GPA requirement (on a 4.0 scale): ☐ 2.00 ☐ 2.50 ☐ 2.75 ☐3.00

Coursework Prerequisites

☐ There are no course prerequisites.

☐ The following language or content course prerequisite is necessary; please list specific AU course:

CRN: Click here to enter text.	Course title: Click here to enter text.

☐ Other prerequisites are needed; please specify: Click here to enter text.

Does the program design involve interaction or collaboration with other universities or colleges in the U.S., or the participation of non-AU students?

☐ Yes; please explain: Click here to enter text.

☐ No

Enrollment

Programs must run with a minimum of 10 students or they will be cancelled. What is the largest group size you would be comfortable with given the location, coursework, costs and timeframe? Click here to enter text.

Marketing and Promotion

Please check all of the marketing avenues you plan to utilize to recruit for your program:

☐ Post flyers on campus

☐ Alfred Today postings

☐ E-mail solicitations

☐ Class visits

☐ Other – please specify:

Click here to enter text.

3.	Academic Design

Program type:	☐ Semester-long course with a short travel component (less than 2 weeks)

☐ A-Block course with a short travel component (less than 2 weeks)

☐ B-Block course with a short travel component (less than 2 weeks)

☐ Summer abroad [two (2) to twelve (12) weeks]

☐ Conference

☐ Allen term course

☐ Other (please describe)

Have you secured approval from the appropriate departments where courses will be accredited (including language departments)?

☐ Yes	☐ No

How many credits will AU students earn on this program?	Click here to enter text.

Who will teach the course(s)?	☐ AU faculty only	☐ AU faculty and host institution faculty

Language(s) of instruction:	☐ English only	☐ English and Click here to enter text.

☐ Instruction only in Click here to enter text.

4. Goals and Objectives [This section should set out specific goals and themes, and cover items that are not addressed in the other questions.

□ Other (specify)

□ Mixed (specify)

What is the rationale for establishing this program? How do the location and local resources enhance the attainment of the learning objectives of the course? (If not a class, how does attending the conference or participating in the international project or activity promote the achievement of the learning objectives of the department or college?)

Click here to enter text.

How does the program design ensure an intercultural experience (e.g., integration with local students, participation in the local academic system, participation in local cultural events, field trips, internships, living with host families, structured analysis of and reflection on the experience)?

Click here to enter text.

6.	Program Support

NOTE: AU sponsors are always responsible for academic design and ensuring program viability.

Academic oversight and quality control for the program will be provided by:

☐ AU academic department/college	☐ AU department and other

Please specify: Click here to enter text.

Pre-departure orientation will be provided by: (e.g., cultural issues, health & safety, academics, etc.)?

☐ AU office of International Programs (required)

☐ Other – please specify: Click here to enter text.

7.	On-Site Conditions and Support

Housing Type	☐ Homestay

☐ Dormitory/student residence

☐ Apartment

☐ Hotel

☐ Other – please specify:
Click here to enter text.

Arranged by	☐ Accompanying faculty member

☐ Host institution

☐ Overseas program provider

☐ Student

Amenities

☐ Private room

☐ Shared room

☐ Private bath

☐ Shared bath

☐ Laundry service

☐ Use of kitchen

☐ Other – please specify:

Click here to enter text.

Program Fee & Payment

OIP will develop a budget for your program that will include the following (as relevant):

Third-party provider charges

Housing

Meal charges

International wire / transfer charges

Exchange rates

The student’s round-trip flight

Required on-site emergency fund contributions

Group leader flight expenses

Additional group leader meal expenses

Group transportation and/or parking expenses

Group gratuities

Any group consultations (e.g. Passport Health)

Other costs as needed

The AU program fee will be charged and collected by Student Accounts as per the following time and cost schedule:

Payment	Due ___ before departure	Percentage of AU Program Fee
1st payment / non-refundable deposit	100 days	20%
2nd payment	75 days	50%
3rd payment / final	45 days	Remaining balance

Cost information will be shared with students via a Program Fee sheet developed by OIP. Please forward any cost information you have when you submit this proposal, including any quotes you have received.

8.	On-site Coordination

Name and contact information for on-site coordinator(s) other than accompanying faculty (if applicable):

Name: Click here to enter text. Title: Click here to enter text. Organization: Click here to enter text.

Contact for (what is their role?): Click here to enter text.

The responsibilities of the accompanying faculty will include on-site orientation, academic advising, crisis management, understanding the mandatory health insurance, familiarity with local emergency services and medical facilities, and 24-hour availability to the students.

The non-AU On-Site Coordinator will be responsible for:

☐ Airport pick-up

☐ Arranging accommodation and meals

☐ Organizing educational travel (e.g., organized tours, field trips)

☐ Other – please specify: Click here to enter text.

9.	For Students with Disabilities

Program can accommodate students with learning disabilities	☐ Yes	☐ No

Program can accommodate students with limited mobility	☐ Yes	☐ No

Program can accommodate students with visual disabilities	☐ Yes	☐ No

Program can accommodate students with auditory disabilities	☐ Yes	☐ No

10.	Student Welfare

In planning a short term study abroad course, faculty are responsible for giving all risk factors due and unbiased consideration. Please make sure to read the relevant health and safety information provided by the State Department and review the activities in your itinerary before answering the questions below. By signing and submitting this application, you certify that you have reviewed the relevant sources listed below (check those you have consulted):

AU will not sponsor faculty-led programming in countries with a current U.S. State Department travel warning.

☐ U.S. State Department Alerts and Warnings: https://travel.state.gov/content/passports/en/alertswarnings.html

☐ OSAC’s Crime & Safety Reports (for all countries visited): https://www.osac.gov/Pages/ContentReports.aspx?

☐ The Center for Disease Control’s Traveler’s Heath Information: http://wwwnc.cdc.gov/travel

Please indicate as appropriate:

Non-violent crime (e.g., theft):	☐ Low	☐ Moderate	☐ High

Violent crime:	☐ Low	☐ Moderate	☐ High

Political instability:	☐ Low	☐ Moderate	☐ High

Natural disasters:	☐ No	☐ Yes; please specify below.

Additional important details or comments: Click here to enter text.

Health Concerns

Will students face any particular or unfamiliar health issues at this program site (e.g., water purification, inoculations?)

☐ No

☐ Yes – please specify: Click here to enter text.

Describe the medical facilities available to participants. Include information on facilities at each of the locations where students will spend a substantial amount of time. (Note: You should be able to get this information from a provider if you are using one. Alternatively, ACE Insurance can provide you with a list of facilities for each of your locations; please contact OIP for login details if needed) – space provided on next page.

Medical facilities:	Click here to enter text.

What procedures will be in place to respond to an emergency (individual incident, group evacuation, etc.)?

Click here to enter text.

Transportation concerns

NOTE: AU requires that any carrier used as part of an AU program have adequate insurance coverage.

Your assessment of the risk of air service as provided in host country:

☐ Low	☐ Moderate	☐ High

Your assessment of the risk of rail service as provided in host country:

☐ Low	☐ Moderate	☐ High

Your assessment of the risk of watercraft service as provided in host country:

☐ Low	☐ Moderate	☐ High

Your assessment of the risk of bus service as provided in host country:

☐ Low	☐ Moderate	☐ High

Your assessment of the risk of other transportation services as provided in host country (please specify):

Click here to enter text.	☐ Low ☐ Moderate ☐ High

Click here to enter text.	☐ Low ☐ Moderate ☐ High

Program Evaluation

Global Perspectives (GP) student evaluation surveys should be submitted to OIP with the end of program report in addition to any other evaluation instruments listed here.

Click here to enter text.

16.	Financial Support

AU sources of support: Click here to enter text.

Outside support: Click here to enter text.

If grant funding, has the grant proposal been submitted and/or approved?

☐ Yes, date submitted: Click here to enter a date.

☐ No, date due: Click here to enter a date.

☐ Approved, date: Click here to enter a date.

17.	Attachments

☐ Syllabus	☐ Budget	☐Itinerary

☐Offer or invoice from provider(s), including payment schedule and cancellation policy

☐ Other; please specify: Click here to enter text.

18.	End of Program Report

An End-of-Program Report must be completed and returned to OIP within one month of the completion of the program along with completed GP evaluation forms. Thank you!