Academic Domestic Travel Planning Flow Chart ............................ 1
Academic International Travel Planning Flow Chart ..................... 2
International Travel Report Request .............................................. 5
Off-Campus Student Program Orientation ..................................... 6
List of Required Forms and Procedures ...................................... 7-8
Quick Guide for Completing R&R Paperwork ............................... 9
Faculty/Staff and Student Responsibilities ..................................... 10
Risk and Responsibility Forms .................................................. 11-20
......................................................................... 21-22
...................................................................... 23-24
............................................................................................. 24
...................................... 25-26
......................................... 27
.......................................... 28
.................................................. 29

Carol DeJong, Registrar
To be reviewed by Amy Otis, Kevin
Kraay and Richard Frost
To be reviewed by Cindy Sabo,
Carolyn Mossing, and Kristen Gray
To be reviewed by
Kevin Kraay
Concerns to be addressed prior to approval of trip
Concerns to be addressed prior to approval of trip
1

Carol DeJong, Registrar
To be reviewed by Amy Otis, Kevin
Kraay and Richard Frost
To be reviewed by
Kevin Kraay
To be reviewed by Cindy Sabo,
Carolyn Mossing, and Kristen Gray
Concerns to be addressed prior to approval of trip
Concerns to be addressed prior to approval of trip
2

Designing, implementing and managing an off-campus May/June/July term requires time! Be sure to submit the appropriate paperwork before departing.
The following 18-month timeline has been created as a guideline for faculty to use while creating a new May/June/July term program.
Submit a May/June/July term proposal to the Registrar’s Office. The Deans’ Council will review, recommend amendments and/or approve the proposed program.
1.
Proposal should include: a.
academic rational b.
proposed itinerary c.
cost and credits d.
number of student participants e.
measurable learning outcomes f.
on-site resources
2.
Use of customized programs through AustraLearn/CIEE/IES a.
Cost of using such a program coordinator?
3.
Questions to be considered (adapted from chapter 2, Education Abroad ) a.
What are the academic and intercultural learning outcomes for the program? b.
How does teaching the course overseas enhance these outcomes? c.
What facilities will be needed for delivering the course content? Are there special needs for classroom space and equipment? d.
Will the program take place in one destination or will participants travel to several destinations? e.
How will transportation to and from the program’s location and during the program be arranged? f.
What arrangements will be made for housing and meals? g.
What will and will not be included in the fees charged? h.
What types of visits, excursions and cultural activities will be included in the curricular portion of the program? When will free time be scheduled? i.
Will additional support staff and faculty be needed? If so, how will they be compensated? Are their expenses covered? j.
Are visas required? k.
Are there any special medical requirements specific to location that should be addressed?
A.
Design off-campus course (adapted from charter 2 , Education Abroad )
1.
Contact hours
2.
Site visits and excursions
3.
Readings
4.
Grading
5.
Learning and intercultural growth
6.
Culture learning
7.
Unstructured time
8.
Group dynamics
9.
Orientation
3

10.
Emergency procedures and contact information a.
List of hospitals, embassies, travel agents, etc. b.
Does each program have a substantial evacuation/medical insurance policy? c.
Follow Risk and Responsibility guidelines in case of emergency
A.
Recruit program participants
1.
Marking materials
2.
Participate in the Off-Campus Study Fair (early October)
3.
Applicant screening and approval process
4.
Finalize program logistics
5.
Clear applicants with Eligibility to Participate form
A.
Hold regular orientation meetings with program participants.
1.
Cultural preparation/cultural competence training
2.
Academic preparation
3.
Health and Safety – informing students of health/safety protocols, designing a personal action plan with each student
4.
Contact the Health Center for proper immunizations
5.
Review medical files
6.
Program schedule, locations, transportation, housing
7.
Extra-curricular activities
8.
Behavioral expectations
9.
Alcohol awareness training (involve the Counseling and Psychological Services office)
10.
Code of conduct (setting group norms signed by students) a.
Group dynamics (exclusions?) b.
Roommate issues c.
Dietary restrictions d.
Punctuality e.
Independent travel
B.
Collect Medical and Mental Health History forms, Assumption of Risk and Release forms,
Student Off-Campus Program Responsibilities forms, and if needed, Off-Campus Study
Social Conduct and Behavior Contracts; collect parent contact information.
1.
Review all material individual with students
2.
Ask for clarification from the Health Center and Counseling and Psychological Services.
C.
Provide program itinerary and all contact information to the Registrar’s Office.
D.
Design a program evaluation and re-entry program.
4

Study Abroad Program
Member of Hope-sponsored group
Independent traveler
Member of Non-Hope group
(if applicable):
 If traveling with a Hope group, will you be returning with the group? YES NO
 Affiliation with IES, CIEE, SIT or other program? If YES, NO
(include airport stop-over’s):
(check all that apply):
Hiking/Backpacking
Scuba diving
High Altitude Climbing
Caving
Safari
Snorkeling
Other
Safari
(check all that apply):
Snorkeling
Street vendors and/or Market stalls
Unknown
Other
(check all that apply):
Air conditioned hotel
Open air window hotel
Screened cabin
Open air tent
Host family
Other
(check all that apply):
Industrialized country
Bottled water
Boiled and/or chemically treated water
Tap water
Other
5
Snorkeling
Other

All off-campus study programs must have an orientation prior to departure that covers the following points. Faculty should also plan for an additional orientation for students on arrival.
What to cover:
 Practical Details o GET TO KNOW YOUR STUDENTS! o Risk and Responsibility Forms
 Set a timeline for turning in completed forms o Passport/Visa Information o Itinerary, with contact information o Packing Information o Financial Issues
 Cultural Preparation and Competence o American cultural traits o U.S. role in politics as it relates to the areas where you are going o What are some of the political/economic issues in the country and region? o What are the communication patterns, social structure, religious beliefs and cultural practices? o What are the general characteristics of male/female roles? o What follow-up, independent preparation can the students be doing o What books might they read?
 Academic Preparation o Academic expectations o What do the students want to achieve? o What can they expect from the instructor? o How can they contribute to the course? o What are their concerns? o How will they get along in a group situation?
 Health/Safety o Necessary immunizations o Medical insurance – especially when traveling overseas o What are the safety issues in the area where you will be study? o What are the health issues? o What are the group’s issues concerning safety (women out alone\men accompanying women, etc.) o Drug and Alcohol awareness training (involve the Counseling and Psychological
Services office)
 Emergencies o “Prevent, Prepare, Respond” o Have an emergency plan
 Primary meeting place
 Secondary meeting place
 How and when to check in o Discuss potential crises o Assign a designated student to know the Recommended Procedures for Emergency
Notification in case the leader is unavailable. o Create a communication tree for students – include student cell phone numbers o Get parent contact information o Share own contact information
6

 All off-campus programs require all applicants to complete the Eligibility to Participate
Form.
This form will be used to determine the student’s eligibility to apply to a program.
 Each program leader is responsible for submitting a list of student in each of the three categories to the Dean of Students: o Never been on disciplinary probation o History of having been on disciplinary probation o Currently on disciplinary probation
This is to confirm the accuracy of student’s statements and to determine student’s eligibility, based on behavior, to have their program applications reviewed for admission.
 Completed forms should be sent to the Dean of Students office. The program leader is also responsible for noting his/her own name and program name on the list of results from the
so the Dean of Students will know to whom to return the results.
 In turn, the following policy will be followed with respect to accepting student on all off-campus programs: o A student not currently on disciplinary probation, but who has a past history of being on probation may be accepted to an off-campus program at the discretion of the program’s director, but may be required to sign an Off-Campus Study Social
Conduct & Behavior Contract.
o A student currently on disciplinary probation at the time of application is subject to a review by the Dean of Student’s. Depending on the circumstances of the probation, the student may still be given permission to apply.
Note: Students on Level I probation may be given permission to apply at the discretion of the Dean of
Students and in conversation with the program leader. Students on Level II probation or Withheld
Suspension will generally not be given permission to apply to an off-campus program while on disciplinary probation (this is detailed in the online Student Handbook). o The principal concern being addressed in this process is student behavior relating to alcohol, drugs, lack of respect for others, including, but not limited to, disorderly conduct, sexual harassment, violations of the law and assault. o If the program leader, Dean of Students or other members of the Hope College community becomes aware of any infractions prior to the program’s departure, the student’s permission to participate may be revoked.

All students participating in an off-campus program are required to sign this form. A parent must sign as well if the student is under 18 years of age.

Completed forms need to be returned to either Liz Steenwyk in the Registrar’s Office for Academic Programs or to Julie Dalman in the Student Development Office for student groups. Please see the Risk and Responsibility Website at http://www.hope.edu/admin/randr/materials.html
for the proper Assumption of Risk and Release form.

If the program is two or more nights, the program leader must provide a complete itinerary with contact phone numbers. An itinerary template can be found on the Risk and Responsibility Webpage http://www.hope.edu/admin/randr/materials.html
7

 All students participating in an off-campus program are required to accurately complete this form. A parent must sign as well if the student is under 18 years of age.
 A photocopy of the front and back of all major medical cards from each participating student is also required.
 Advise students to purchase the International Student ID card or iNext travel Card for international programs. These cards include medical insurance that is valid worldwide.
 There forms should be carefully reviewed with the individual students prior to leaving for the trip.
 The program leader should take the original forms along on the program. Copies of the forms should be left with the department secretary in a sealed envelope.
 All students participating in an off-campus program are required to sign this form.
 The program leader should keep completed forms and take them along on the program. Send copies to the Dean of Students.
 This form is to be filled out at the discretion of the program leader and the Dean of
Students. It encourages students to take responsibility for their actions. The program leader must also sign the form.
 The program leader should keep completed forms and take them along on the program. Send copies to the Dean of Students.
 This card should be completed by the student and kept in their wallet throughout the program in case of emergency.
 Cards are available in the Registrar’s and/or the Student Development Office.
The Smart Traveler Enrollment Program (STEP) is a free service provided by the U.S.
Government to U.S. citizens who are traveling to, or living in a foreign country. STEP
allows you to enter information about your upcoming trip abroad so that the Department of
State can better assist you in an emergency. When registering your trip, you will first be
asked to create an account. The account type you need to select is “Organizational
Account”, as this is intended for colleges and universities that will be creating trips for a
number of individuals.
For More Information, please go to https://step.state.gov/step/
8

Assumption of Risk and
Release for One day/One
Overnight Programs
Student Groups: Submit to Julie Dalman, Student Development at least 48 business hours before leaving.
Off-Campus Student Social
Conduct and Behavior
Academic Travel: Submit to Liz Steenwyk, Registrar’s Office at least
48 business hours before leaving.
Emergency Medical Info Card Student should have these cards already.
If necessary, order more cards from Julie Dalman, Student Development
OPTIONAL – Take original forms with you . Send copies to Julie
Dalman, Student Development
Contract
Eligibility to Participate
Assumption of Risk and
Release for One day/One
Overnight Programs
Student Groups: Submit to Julie Dalman, Student Development at least 72 business hours (3 days) before leaving.
Student Groups: Submit to Julie Dalman, Student Development at least 48 business hours before leaving.
Academic Travel: Submit to Liz Steenwyk, Registrar’s Office at least
48 business hours before leaving.
Emergency Medical Info Card Student should have these cards already.
If necessary, order more cards from Julie Dalman, Student Development
Student Off-Campus Programs Take original forms with you. Send copies to Julie Dalman, Student
Responsibilities
Off-Campus Student Social
Conduct and Behavior
Contract
Development
OPTIONAL – Take original forms with you . Send copies to Julie
Dalman, Student Development
Eligibility to Participate
Assumption of Risk and
Release for Two or More
Nights
Please be sure to complete the proper form for either a Domestic or International program
Student Groups: Submit to Julie Dalman, Student Development at least 72 business hours (3 days) before leaving.
Student Groups: Submit to Julie Dalman, Student Development at least 48 business hours before leaving.
Academic Travel: Submit to Liz Steenwyk, Registrar’s Office at least
48 business hours before leaving.
You must include an itinerary and contact info .
Medical and Mental Health
History
Take original CONFIDENTIAL forms with you. Leave copies with department secretary in a sealed envelope.
Emergency Medical Info Card Student should have these cards already.
If necessary, order more cards from Julie Dalman, Student Development
Student Off-Campus Programs Take original forms with you. Send copies to Julie Dalman, Student
Responsibilities
Off-Campus Student Social
Conduct and Behavior
Contract
Development
OPTIONAL – Take original forms with you . Send copies to Julie
Dalman, Student Development
9

The faculty/staff leader role is one of significant importance. In order for the coordination and execution of the off-campus program to be successful it will be key that the program leader understand and complete the following list of responsibilities.
 A faculty/staff leader will accompany all off-campus programs that include students.
 Collect and submit all necessary Risk and Responsibility forms as outlined to the appropriate offices (see page 9-10).
 In advance of departure, conduct an appropriate orientation program for all participants (see page 8).
 Contact the Health Center for a Travel Clinic tailored for your program’s location.
 Consult with the Health Center and/or Counseling and Psychological Services Office on all medical and/or psychological conditions that impact students traveling with you.
 Meet and discuss with flagged students what you should know about their medical conditions and have a written plan of action as needed.
 Carry copies of major medical cards, proof of immunizations and other important documents away from the originals. For international programs, carry copies of the front page of all passports and any necessary visas.
 Notify the College in the event of an itinerary change and/or emergency within the group or location of program.
 Follow and use the Recommended Procedures for Emergency Notification .
As a participant in an off-campus study program the student must understand and complete the following list of responsibilities.
 The student must complete all Risk and Responsibility forms. o Eligibility to Participate to be completed before applying to the program. o Assumption of Risk and Release o Medical and Mental Health History Form o Student Off-Campus Program Responsibilities
 Student is required to maintain good standing after a program accepts them. This means that they must maintain good academic standing as well as good social standing.
 Student must obtain all required and recommended immunizations for travel, as determined by the Health Center.
 Student must attend all required on-campus orientation session(s).
10

Please complete and sign this authorization. Give this form with your application to the leader of the off-campus program for which you wish to apply.
Student Name: ________________________________________Student ID ____________________
Off-Campus Program: _________________________________________________________________
Program Dates: _______________________________________________________________________
Program Leader: ______________________________________________________________________
Program Leader phone number:________________________ Email:__________________________
******************************************************************************
Student Authorization:
By signing this form I am indicating that I wish to apply to participate in the above designated, non-required off-campus program(s), and that I also authorize the release of information needed to verify this form by the
Registrar, Dean of Students, Director of International Education, or their contacts(s), in order to determine my eligibility to submit an application for off-campus study.
I unconditionally and voluntarily consent to the release of such records pursuant to this request.
Disciplinary Information (please check one):
I am not and have never been on disciplinary probation.
I am currently not on disciplinary probation, but have been in the past.
Explain:
I am currently on disciplinary probation.
Explain:
Note: I further recognize and acknowledge, that should my judicial or student status change prior to my offcampus program’s departure date, I may be denied permission to participate.
Signature__________________________________________ Date______________________
**NOTE TO PROGRAM LEADER: A copy of each students form must be sent to the Dean of
Students no less than 72 Business hours before departure. Unless otherwise noted, the Dean’s email response will be sent to the Program Leader noted above.
Revised 7.20.09
11

12

THIS IS A LEGAL DOCUMENT - READ CAREFULLY BEFORE SIGNING.
This document pertains to the following program or activity (the “Program”) which is either sponsored by Hope College (the “College”) or other entity (the “Sponsor”).
Name of Program: ________________________________________ Faculty/Group Leader: _________________________________________
Name of Student: _________________________________________ Student’s Date of Birth: ________________________________________
Location(s): _____________________________________________ Approximate Date(s): __________________________________________
In consideration of the opportunity to participate in the above-identified off-campus program or activity, the undersigned has read, understands, and agrees to the following:
1.
Certification of Health Insurance Coverage . I am presently covered by standard health insurance providing for medical treatment, and such insurance will be fully effective during the entire period of my participation in the Program. My health insurance information is as follows:
Name of the insuring company: ___________________________________________________
Group number of the policy: __________________________ My individual policy number: __________________________
2.
Emergency Contact Data .
•
Primary Contact Name________________________________________ Relationship to You_____________________________
Daytime Phone______________________________________________ Evening Phone_________________________________
•
Secondary Contact Name______________________________________ Relationship to You_____________________________
Daytime Phone______________________________________________ Evening Phone_________________________________
3.
Voluntary Participation . I am a student at Hope College and request permission from Hope College to participate in the Program. I fully realize that this Program is not necessary for the achievement of my degree, and that I am not being forced in any way to take part in this
Program. I voluntarily choose to participate in this Program. I affirm that all of the statements and representations made in connection with my application to participate in this Program are complete, accurate, and truthful.
4.
Risks of Program . I understand that this Program involves travel and living in other locations which may expose me to certain risks and dangers. Some of these risks include, but are not limited to, the following:
•
The hazards of travel by airplane, boat, train, bus, car, or other forms of transportation;
•
Different or unstable social or economic conditions;
•
Local health and weather conditions;
•
The potential of criminal or injurious acts by others, including terrorism;
•
Physical exertion or emotional distress associated with length of travel or activities undertaken;
•
Exposure to infectious, communicable, and other diseases;
•
Loss of valuable personal property;
•
Injury resulting in serious, permanent physical injury, or even death, resulting from accident, natural disasters or acts of God; from strikes, civil unrest, quarantine or government restrictions; or from medical care or treatment received while participating in the Program;
•
Lack of competent medical services;
•
And also the following risks specific to the Program:
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
I understand and knowingly assume these risks.
5.
Fitness to Participate . Understanding the above-mentioned risks, and understanding that participation in this Program may subject me to physical exertion, I hereby state that (unless I have informed Hope College otherwise in writing) I am physically fit to participate in this activity. I have also provided Hope College or the Program Sponsor with written information regarding any health or medical conditions I have, including prescriptions, and consent to this information being disclosed to any health care providers in connection with any treatment I receive.
6.
Release of Claims . Knowing the risks described above, and in consideration of being allowed to participate in the Program, I herby assume all risks and responsibilities surrounding my participation in the Program. I herby release Hope College, their respective officers, trustees, agents, other loss of any kind that I may sustain as a result of my participation in the Program, whether such loss results from the negligence of such

released parties or otherwise. I further agree to indemnify and hold harmless Hope College, its officers, trustees, agents, and employees from any and all loss, liability, damage, or costs that it or they may incur as a result of my participation in the Program or arising from any of my acts or omissions, including reasonable attorneys’ fees.
7.
Compliance with Rules and Policies . I agree to comply with all the rules, regulations, and policies of Hope College or other Sponsor, including those applicable generally and those pertaining specifically to the Program. I acknowledge that the Program director or other authorized officials may from time to time establish rules and policies for the Program which may be announced orally or in writing. I understand that each state, territory, or reservation has its own laws and may have cultural standards that may be different than what I am accustomed to. I recognize that conduct which violates those laws or cultural standards could harm Hope College’s reputation, as well as my own health and safety. I will abide by all laws for each state (including the District of Columbia), territory, or reservation through which I will travel or am present in during my participation in the Program. I also agree that I will be responsible for all expenses associated with any legal problems resulting from or caused by my conduct. I recognize that the Program director is authorized to determine the fitness of any student to continue participation in the Program, and that the Program director may do so based on whatever information he or she finds sufficient. The
Program director may also implement individual discipline in his or her discretion. If I am requested to leave the Program by an authorized representative of Hope College because of my failure to comply with the requirements of this paragraph, I will do so. In the event my participation in the Program is so terminated by Hope College, I consent to being sent home at my own expense with no refund of fees, including tuition, and I will hold Hope College harmless from the expense of my return home. If a matter arises which is properly the subject of consideration under the Hope College judicial process, I understand that the matter will be brought to the attention of the appropriate officials upon my return to campus; I understand that the time periods for such adjudication process may be adjusted accordingly.
8.
Parental/Guardian Notification . I consent to Hope College and/or the Sponsor notifying my parents or guardian regarding any health, safety, disciplinary, legal, or other issue relating to my conduct and participation in the Program.
9.
Medical Treatment Authorization . I agree that I will be responsible for ascertaining and attending to my own health and medical needs at all times during my participation in the Program. Hope College and/or the Sponsor, and all of their respective officers, trustees, agents, and employees are authorized (but are not obligated) to take any actions (including notification of my parents or guardian) they consider to be warranted under the circumstances regarding my health and safety. I agree to pay all expenses related thereto and hereby release Hope College and/or the Sponsor, and all of their respective officers, trustees, agents, and employees from any liability for any such actions or for payment for such authorized treatment.
10.
Program Changes . Hope College or the Sponsor has the right to make cancellations, substitutions, or changes in the case of emergency or changed conditions, including the level of participant interest in the Program. I accept all responsibility for loss or additional expenses due to delays or other changes in the means of transportation, other services, or sickness, weather, strikes, civil unrest or other unforeseen causes. I understand that Hope College and/or the Sponsor is not responsible for any such disruptions in the Program, nor for any consequent expenses I may thereby incur. If I become detached from the Program group, fail to meet a departure bus, airplane, boat, train, or other transit, or become sick or injured, I will, at my own expense and risk, seek out, contact, and reach the Program group at its next available destination. I acknowledge that I have been advised of the availability of “trip insurance,” which I may elect to purchase at my own cost, to reimburse any losses (for example, for medical evacuation) which I may suffer due to unexpected cancellation or early termination of my participation in the
Program; I understand, however, that such insurance coverage does not extend to reimbursement for tuition paid to Hope College.
11.
Binding Effect; Construction; Forum .
I acknowledge that this contract will bind members of my family, my spouse, heirs, assigns, and personal representative. The contact will be construed under the laws of the State of Michigan, and agree that any lawsuits filed under or incident to this agreement or to the Program shall be brought in the state of Michigan.
12.
Savings Clause . In the event that any part of this agreement is deemed unlawful, void, or otherwise unenforceable or invalid by a competent tribunal, then to the extent possible, such provision shall be rewritten so as to make the provision enforceable to the maximum extent permitted by law. If the provision is not enforceable at all, then only that unenforceable provision shall be voided and severed from the remainder of this agreement. The remainder of this agreement shall remain in full effect and shall be interpreted and enforced to the maximum extend permitted by law.
13.
I UNDERSTAND THAT THIS DOCUMENT CONTAINS A RELEASE OF LIABILITY AND IS INTENDED TO HAVE A BINDING
EFFECT UPON MY SUBSTANTIVE LEGAL RIGHTS. I REPRESENT THAT I HAVE READ THIS STATEMENT CAREFULLY
AND THOROUGHLY; I UNDERSTAND AND AGREE TO ALL OF THE TERMS STATED ABOVE; AND, I HAVE EXECUTED
THIS STATEMENT VOLUNTARILY.
Signature of Student: ______________________________________________ Date: ________________
Printed Name of Student: ___________________________________________ Student’s Date of Birth: ____________________
................................................................................................................................................................................................................................................
If Student is under 18 years of age:
I (a) am the parent or legal guardian of the above Student; (b) have read and understand the foregoing Release Form (including such parts as may subject me to personal financial responsibility); (c) am and will be legally responsible for the obligations and acts of the Student as described in this Release Form; and (d) agree, for myself and for the Student, to be bound by its terms.
Signature of Parent/Guardian: ______________________________________________ Date:________________
14

THIS IS A LEGAL DOCUMENT - READ CAREFULLY BEFORE SIGNING.
This document pertains to the following international program or activity (the “Program”) which is either sponsored by Hope College (the “College”) or other entity (the “Sponsor”).
Name of Program: ________________________________________ Faculty/Group Leader: _________________________________________
Name of Student: _________________________________________ Student’s Date of Birth: ________________________________________
Location(s): _____________________________________________ Approximate Date(s): __________________________________________
In consideration of the opportunity to participate in the above-identified off-campus program or activity, the undersigned has read, understands, and agrees to the following:
1.
Certification of Health Insurance Coverage . I am presently covered by standard health insurance providing for medical treatment, and such insurance will be fully effective during the entire period of my participation in the Program. My health insurance information is as follows:
Name of the insuring company: ___________________________________________________
Group number of the policy: __________________________ My individual policy number: __________________________
2.
Emergency Contact Data .
•
Primary Contact Name________________________________________ Relationship to You_____________________________
Daytime Phone______________________________________________ Evening Phone_________________________________
•
Secondary Contact Name______________________________________ Relationship to You_____________________________
Daytime Phone______________________________________________ Evening Phone_________________________________
3.
Voluntary Participation . I am a student at Hope College and request permission from Hope College to participate in the Program. I fully realize that this Program is not necessary for the achievement of my degree, and that I am not being forced in any way to take part in this
Program. I voluntarily choose to participate in this Program. I affirm that all of the statements and representations made in connection with my application to participate in this Program are complete, accurate, and truthful.
4.
Risks of Program . I understand that this Program involves international travel and living in a foreign country, and exposes me to certain risks and dangers. Some of these risks include, but are not limited to, the following:
•
The hazards of travel by airplane, boat, train, bus, car, or other forms of transportation;
•
Different or unstable political, legal, social, and economic conditions;
•
Local health and weather conditions;
•
The potential of criminal or injurious acts by others, including terrorism;
•
Physical exertion or emotional distress associated with length of travel or activities undertaken while abroad;
•
Exposure to infectious, communicable, and other diseases;
•
Loss of valuable personal property;
•
Injury resulting in serious, permanent physical injury, or even death, resulting from accident, natural disasters or acts of God; from strikes, war, insurrection, civil unrest, quarantine or government restrictions; or from medical care or treatment received while abroad;
•
Lack of competent medical services;
•
And also the following risks specific to the Program:
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
I understand and knowingly assume these risks.
5.
Fitness to Participate . Understanding the above-mentioned risks, and understanding that participation in this Program may subject me to physical exertion, I hereby state that (unless I have informed Hope College otherwise in writing) I am physically fit to participate in this activity. I have also provided Hope College or the Program Sponsor with written information regarding any health or medical conditions I have, including prescriptions, and consent to this information being disclosed to any health care providers in connection with any treatment I receive.
6.
Release of Claims . Knowing the risks described above, and in consideration of being allowed to participate in the Program, I herby assume all risks and responsibilities surrounding my participation in the Program. I herby release Hope College, their respective officers, trustees, agents, and employees from any and all liabilities, claims, or demands for damages for personal injury, disability, death, property loss or damage, or other loss of any kind that I may sustain as a result of my participation in the Program, whether such loss results from the negligence of such

released parties or otherwise. I further agree to indemnify and hold harmless Hope College, its officers, trustees, agents, and employees from any and all loss, liability, damage, or costs that it or they may incur as a result of my participation in the Program or arising from any of my acts or omissions, including reasonable attorneys’ fees.
7.
Compliance with Rules and Policies . I agree to comply with all the rules, regulations, and policies of Hope College or other Sponsor, including those applicable generally and those pertaining specifically to the Program. I acknowledge that the Program director or other authorized officials may from time to time establish rules and policies for the Program which may be announced orally or in writing. I understand that each foreign country has its own laws and standards of acceptable conduct, including those related to dress, manners, morals, politics, drug use, and behavior. I recognize that conduct which violates those laws or standards could harm Hope College’s relations with those countries and the institutions therein, as well as my own health and safety. I will become informed of and abide by all such laws and standards for each country to or through which I will travel during my participation in the Program. I agree that I will be responsible for all expenses associated with any legal problems resulting from or caused by my conduct. I recognize that the Program director is authorized to determine the fitness of any student to continue participation in the Program, and that the Program director may do so based on whatever information he or she finds sufficient. The Program director may also implement individual discipline in his or her discretion. If I am requested to leave the Program by an authorized representative of Hope College because of my failure to comply with the requirements of this paragraph, I will do so. In the event my participation in the Program is so terminated by Hope College, I consent to being sent home at my own expense with no refund of fees, including tuition, and I will hold Hope College harmless from the expense of my return home. If a matter arises which is properly the subject of consideration under the Hope College judicial process, I understand that the matter will be brought to the attention of the appropriate officials upon my return to campus; I understand that the time periods for such adjudication process may be adjusted accordingly.
8.
Parental/Guardian Notification . I consent to Hope College and/or the Sponsor notifying my parents or guardian regarding any health, safety, disciplinary, legal, or other issue relating to my conduct and participation in the Program.
9.
Medical Treatment Authorization . I agree that I will be responsible for ascertaining and attending to my own health and medical needs at all times during my participation in the Program. Hope College and/or the Sponsor, and all of their respective officers, trustees, agents, and employees are authorized (but are not obligated) to take any actions (including notification of my parents or guardian) they consider to be warranted under the circumstances regarding my health and safety. I agree to pay all expenses related thereto and hereby release Hope College and/or the Sponsor, and all of their respective officers, trustees, agents, and employees from any liability for any such actions or for payment for such authorized treatment.
10.
Program Changes . Hope College or the Sponsor has the right to make cancellations, substitutions, or changes in the case of emergency or changed conditions, including the level of participant interest in the Program. I accept all responsibility for loss or additional expenses due to delays or other changes in the means of transportation, other services, or sickness, weather, strikes, or other unforeseen causes. I understand that
Hope College and/or the Sponsor is not responsible for any such disruptions in the Program, nor for any consequent expenses I may thereby incur. If I become detached from the Program group, fail to meet a departure bus, airplane, boat, train, or other transit, or become sick or injured, I will, at my own expense and risk, seek out, contact, and reach the Program group at its next available destination. I acknowledge that I have been advised of the availability of “trip insurance,” which I may elect to purchase at my own cost, to reimburse any losses (for example, for medical evacuation) which I may suffer due to unexpected cancellation or early termination of my participation in the Program; I understand, however, that such insurance coverage does not extend to reimbursement for tuition paid to Hope College.
11.
Binding Effect; Construction; Forum .
I acknowledge that this contract will bind members of my family, my spouse, heirs, assigns, and personal representative. The contact will be construed under the laws of the State of Michigan, and agree that any lawsuits filed under or incident to this agreement or to the Program shall be brought in the state of Michigan.
12.
Savings Clause . In the event that any part of this agreement is deemed unlawful, void, or otherwise unenforceable or invalid by a competent tribunal, then to the extent possible, such provision shall be rewritten so as to make the provision enforceable to the maximum extent permitted by law. If the provision is not enforceable at all, then only that unenforceable provision shall be voided and severed from the remainder of this agreement. The remainder of this agreement shall remain in full effect and shall be interpreted and enforced to the maximum extend permitted by law.
13.
I UNDERSTAND THAT THIS DOCUMENT CONTAINS A RELEASE OF LIABILITY AND IS INTENDED TO HAVE A BINDING
EFFECT UPON MY SUBSTANTIVE LEGAL RIGHTS. I REPRESENT THAT I HAVE READ THIS STATEMENT CAREFULLY
AND THOROUGHLY; I UNDERSTAND AND AGREE TO ALL OF THE TERMS STATED ABOVE; AND, I HAVE EXECUTED
THIS STATEMENT VOLUNTARILY.
Signature of Student: ______________________________________________ Date: ________________
Printed Name of Student: ___________________________________________ Student’s Date of Birth: ____________________
................................................................................................................................................................................................................................................
If Student is under 18 years of age:
I (a) am the parent or legal guardian of the above Student; (b) have read and understand the foregoing Release Form (including such parts as may subject me to personal financial responsibility); (c) am and will be legally responsible for the obligations and acts of the Student as described in this Release Form; and (d) agree, for myself and for the Student, to be bound by its terms.
Signature of Parent/Guardian: ______________________________________________ Date:________________
16

□ Student:
Return this form to your Program Leader.
□ Program Leader:
Take original forms with you.
Leave copies with your department secretary in a sealed envelope.
Faculty/Staff Leader:
Name:
(print clearly) (mo/day/yr)
Name:
Address:
Phone:
Name:
Parent(s)/Guardian(s) Information:
Name:
Address:
Phone:
Emergency Contacts:
Name:
---------------------------------------------------------------------------------------------------------------------------------------
List all allergies you have: List any dietary restrictions:
Medication:____________________________________________
______________________________________________________
______________________________________________________
†
Vegetarian (total)
†
Vegetarian (partial – specify):
Food: ________________________________________________
______________________________________________________
______________________________________________________
Environment: __________________________________________
______________________________________________________
______________________________________________________
_____________________________
†
Vegan
†
Lactose Intolerant
†
Other (specify):
_____________________________
_____________________________
Animal: _______________________________________________
______________________________________________________
______________________________________________________
Other – specify:_________________________________________
______________________________________________________
_____________________________________________________
Bee stings ?
Yes No
Do you currently smoke?
Yes No
Hospitalized for
Surgeries for:
(condition, date, location)
________________________________________
________________________________________
________________________________________
(condition, date, location)
________________________________________
________________________________________
________________________________________
Major Medical Insurance:
Company Name:________________________________________
Phone #:______________________________________________
Policy #:______________________________________________
Group #:______________________________________________
*A copy of both the front & back of your insurance card must accompany this form.
Primary Care Physician:
Name:___________________________________________
Address:_________________________________________
___________________________________________
Phone:___________________________________________
Fax:_____________________________________________
17

Health History:
(mark all that apply)
Currently
AutoImmune Disorders
under treatment for
Past
treatment for
List any special directions to be followed in case of an emergency:
_________________________________
Other:________________________________________________________
Blood Disorders
_________________________________
_________________________________
Anemia_______________________________________________________
_________________________________
Cancer
Cardio/Pulmonary Disorders
_________________________________
_________________________________
High Blood Pressure_____________________________________________
_________________________________
_________________________________
_________________________________
_________________________________
Other:________________________________________________________
Communicable Disease:
_________________________________
Other:________________________________________________________ List medications you are currently taking and
Digestive Disorders
Crohn's Disease_________________________________________________ the condition(s) for which they have been prescribed:
_________________________________
_________________________________
Eating Disorders
Binge Eating___________________________________________________
_________________________________
_________________________________
Mental/Emotional Disorders
Other:_________________________________________________________
Neurological Disorders
_________________________________
ADD/ADHD___________________________________________________
Cerebral Palsy__________________________________________________
Date of your last Tetanus booster:
Seizures_______________________________________________________
Other:_________________________________________________________
Other:
_______________________________________________________________
__________________________
*For injury – another booster is needed if date
I have provided the information given above in connection with my application to join a program of off-campus study (the “Program”) that is being sponsored by
Hope College or is being sponsored by a third party and available to students of Hope College. In signing this form below, I authorize Hope College, the Program sponsor and any of their respective agents or employees to take any and all actions that they may deem necessary or appropriate, at my expense, in order to treat and respond to any accident, illness, injury or other medial emergency that I may experience during my participation in the Program. I understand that such treatment and response may include transporting me, at my expense, to a location appropriate for medical treatment (which may, in the case if International Programs, involve transporting me back to the United
States). I understand that in the event of accident, illness, injury or other medical emergency Hope College and/or the Program sponsor shall use its best efforts to promptly inform the person(s) I have listed on this form, but I agree that neither Hope College nor the Program sponsor shall have any liability for a failure to notify such person(s). I further understand and agree that all information given above shall be shared with all Program leader(s) and the Hope College Health Center Director or their representative.
Nothing in this Medical Information Form shall be construed so as to modify or abridge any acknowledgement or waiver of liability contained in the Assumption of
Risk and Release, or in any other document or agreement which I have or may in the future execute in connection with my participation in the Program.
I, _______________________________, certify that I have personally completed this form. The information contained here in is complete and I have not withheld any medical or mental health information. If any aspect of my health profile changes between submitting this form and my departure for an off-campus program, I will notify the director of this/these change(s) in writing. Failure to disclose any medical or mental health information will result in my immediate return to the United States at my expense, including first class airfare if no coach class seat is immediately available.
*Parent or Guardian’s Signature - Required if student is under age 18 on date of signing Date
18

STUDENT OFF-CAMPUS PROGRAM RESPONSIBILITIES
I understand that, as part of my participation in the ______________________________________ ( insert program name ) off-campus program or activity, I am responsible for:
1. Assuming responsibility for fully preparing to participate in the Program, including payment of all fees in a timely manner, and to participate fully in the Program.
2. Reading and carefully considering all materials issued by all persons acting on behalf of Hope College or other Sponsor representatives that relate to safety, health, legal, environmental, and other conditions that exist at the Program location.
3. Consulting with my health care provider(s) with regard any and all medical/mental health matters relating to my participation in the Program.
4. Obtaining and maintaining appropriate health insurance coverage, which provides coverage for illnesses or injuries I may sustain or experience while in the Program, and specifically at the Program location where I will be living and/or traveling, and abiding by any conditions imposed by the carrier.
5. Informing my parents/guardians/families and any others who may need to know about my participation in the Program, providing them with emergency contact information, and keeping them informed of my whereabouts and activities.
6. Understanding and complying with the terms of participation, codes of conduct, and emergency procedures of the Program.
7. Being aware of local conditions that may present health or safety risks when making daily choices and decisions. I will also promptly express any health or safety concerns to Hope College or other Sponsor representatives or other appropriate individuals before and/or during the Program.
8. Accepting responsibility for my own decisions and actions.
9. Obeying laws at the Program location.
10. Behaving in a manner that is respectful of the rights and well-being of others and encouraging others to behave in a similar manner.
11. Avoiding illegal drugs as governed by the laws of Michigan, the United States, and the Program location, and avoiding excessive or irresponsible consumption of alcohol.
12. Following the Program policies for keeping Hope College or other Sponsor representatives informed of my whereabouts and well-being.
13. Informing Hope College or other Sponsor representative of any medical conditions that might adversely affect my safety, or the safety of other persons participating in the Program, including any medical conditions that might require emergency assistance.
Printed Student Name: _________________________________________
Student Signature: ____________________________________________ Date: __________________
Student : Return this form to your program leader.
Program Leader : Take the original forms with you. Leave copies with the Dean of Students.
19

20

Experts recommend that following steps before your departure:
1. See your physician for a physical and the necessary immunizations (if any). This must be done at least one month in advance of departure to allow time for immunizations to take effect.
2. Make copies of all important records (immunizations, prescriptions, etc.) and take them with you. Make sure the prescriptions are written in generic as well as brand names.
3. Take a medical kit along with you (Band-Aids, aspirin, gauze, sterile cleaners, a small tube of antibiotic cream, Pepto-Bismol, etc.)
4. See your dentist and complete all needed work before departure.
If you need medical help abroad, check with the on-site program director(s) for reliable doctors. If you are traveling and need a doctor, contact an American Embassy or Consulate.
Before departure, it is recommended that you contact IAMAT (The International Associate of
Medical Assistants to Travelers) at http://www.iamat.org/ or (716) 754-4883 for a list of Englishspeaking doctors abroad.
 If you are suffering from a health condition that is not easily detected or quickly recognizable, you should secure a medic alert emblem to wear. Contact the Medic Alert
Foundation at www.medicalert.org
or (888) 633-4298.
 A good guide on handling health problems while traveling is Traveler’s Health: How to
Stay Healthy Abroad by Dr. Richard M. Dawood.
For both faculty and students, going abroad is not a magic “geographic cure” for concerns and problems at home. Both physical and emotional health issues will follow you wherever you go.
In particular, if you have a concern, medical or emotional, you should address it honestly before making plans to travel.
Hope College believes that the entire campus community is best-served when every student is immunized. The Ottawa County Health Department fully supports the policy of Hope College that requires immunization of all students prior to foreign travel. Being fully immunized is the best way to ensure the health and medical safety of the student during travel, as well as the safety of local residents upon the student’s return.
Check with the Health Center to see what shots or precautions are recommended for your program. Check early (at least one month in advance) to allow time for vaccinations. In addition, check the Center for Disease Control’s website specifically for travelers: www.cdc.gov/travel . Contact the Health Center for an individualized travel clinic tailored to your program.
You may also call the International Traveler’s Hotline , developed by the Center for Disease
Control at (877) 394-8747 for more detailed information on vaccinations, food and water and diseases of specific areas of the world, etc. Every other year, the CDC publishes the Yellow
Book, “ Health Information for International Travelers ”, updating vaccinations and health risks for travelers. You are able to purchase a copy through Barnes and Nobles or Amazon for approximately $30.
21

It is a good time to update your health records, eyeglass and contact lens prescriptions, and prescriptions for any medications you routinely take. Carry your prescription medications in their original containers and carry written prescriptions using generic names to facilitate getting them filled overseas, should this be necessary. Prescriptions should be accompanied by a letter from your physician. This letter should include a description of the problem, the dosage of prescribed medications to assist medical authorities during an emergency and the generic name of any medicine listed.
Food overseas may be quite different from what you are used to at home. It may be
“healthier” in some instances (more vegetables and fruits) or “less healthy” in others (more fried foods than you may usually eat), but most often it will be just different from what you are used to. Eat nutritiously, which may mean trying some foods you are not accustomed to.
Make sure to take special dietary needs into account and make arrangements in advance.
Despite the change in your environment, you can still keep some of your daily routines from home. Get enough rest, especially the first few days. Get plenty of exercise to keep your mind and body working. This is an essential part of any overseas experience and, more importantly, your emotional wellbeing.
Jet Lag can produce conditions such as exhaustion, irritability and difficulty in making decisions. Here are some suggestions for fighting jet lag:
1.
When traveling eastbound, sleep on the plane until your destination’s breakfast time.
2.
When you wake up, eat a high-protein breakfast and try to stay awake and active during the daylight hours.
3.
Avoid alcohol and caffeinated beverages until your body has had time to adjust to the new schedule.
4.
Melatonin is useful in falling asleep for the first three nights when traveling east.
It is imperative to take proper precautions to safeguard oneself against the AIDS virus. A brochure, Travel Safe: AIDS and International Travel , has been published by the CIEE to inform international travelers about AIDS. It describes some general precautions against the virus which you can follow, regardless of where you are in the world. A copy of this brochure is available in the International Office
22

The consumption of alcoholic beverages is prohibited at all Hope College sponsored functions, not matter where they are located. Faculty members accompanying groups of students on offcampus study programs will discuss the guidelines for responsible use of alcohol with the students in their group prior to departing on the program.
 A student abides by the laws of the country or state in which they are living.
 A student does not miss any scheduled event because of the effects of alcohol consumption.
 A student does not become ill due to the effects of alcohol consumption.
 A student does not engage in inappropriate behavior toward other individuals that is the result of alcohol consumption.
 A student does not engage in destructive behavior toward property that is the result of alcohol consumption.
 A student does not engage in behavior that causes embarrassment to the other members of the group, the faculty member(s), or the in-country host(s) as a result of alcohol consumption.
 Students in a group do not facilitate or encourage or ignore a fellow student who is abusing alcohol. Providing alcohol to persons under the legal drinking are is illegal and against the Hope College policy.
 Transporting quantities of alcohol to program sites with the intent of sharing the alcohol with members of the group is considered to be an irresponsible use of alcohol and a violation of the substance abuse policy.
Students are encouraged to use good judgment if consuming alcohol during non-program hours. Students living in accommodations provided by Hope College will be considered the same as residence halls on the Hope College campus. Therefore, they will be under the same alcohol policy.
If a student becomes incapacitated due to alcohol overuse, or if they are in need of medical attention, students are encouraged to contact the faculty member immediately, in order to protect the health and wellbeing of the affected student. Students are encouraged to make the responsible choice to notify faculty or emergency personnel quickly.
All U.S. legal restrictions on use of drugs apply to all Hope College programs.
American visitors abroad are particularly vulnerable when it concerns violations, intentional or unintentional , of local rules and regulations concerning alcohol, and in particular, drugs. The process of law and punishment is far more arbitrary than within the United States and more often than not may lead to prolonged imprisonment under substandard conditions. It is of utmost importance for the welfare of the student to use extreme caution when it concerns these matters.
The use, purchase, or sale of illegal drugs (hallucinogens, narcotics, stimulants, or depressants) is a critical issue. Any student who uses, buys, or sells illegal drugs will be expelled from the program and immediately returned to the United States at his/her own expense.
One violation will be cause for removal from the program.
Separation from the program will results in loss of academic credit. The costs of legal advice, fines, and return travel must be borne by the violator. Hope College prohibits the unlawful possession, distribution, or use of
23

illicit drugs and/or controlled substances on any property owned or rented by the College or any program or activity sponsored by the College in any location.
Anyone violating policy regarding illicit drugs, and/or controlled substances will be subject to disciplinary action and they may face additional actions by the courts.
Faculty and staff at Hope College have extensive experience in all aspects of operating offcampus programs. Student study in various parts of the United States and the world for one month to one year.
In planning these programs, the concern for the safety of our students and faculty is given careful attention. We know that there are risks involved in travel. Therefore it is important to prepare for both the known and unknown circumstances. The goal is to “manage risk” to the greatest extent possible and to communicate this to student in all material given to them.
During the excitement of travel and the newness of the environment you are in, make it easy to become distracted and less aware of your surroundings. The following suggestions offer a guideline to good common sense. The idea is to be aware of where you are and what is going on around you at all times.
1.
Obey the law and respect the customs of the host country.
2.
Dress conservatively and appropriately on all occasions, PARTICULARLY when you visit places of worship. Short skits and tank tops may be comfortable, but they may also encourage unwanted attention. Remember that in some areas how you dress may send signals you do not intend to convey.
3.
Never leave your baggage unattended; everything you own is in it. A thief knows this and will take advantage of even a few seconds of your inattention.
4.
Protect your valuable documents. Carry these in a safe place at all times.
5.
Don’t forget you are a foreigner in the host country and, as such, should be wary of the opportunities otherwise available to a national. For example, it is unwise for you to get involved in a political demonstration. Be wary of strangers selling merchandize at discount prices, they may be selling stolen goods.
6.
Plan where you are going and use the buddy system. Be aware of your surroundings.
You know what feels comfortable and what doesn’t. Do not agree to meet a person whom you do not know in a secluded place. If your instincts tell you a situation is uncomfortable or dangerous, trust them and move along. If you become lost, ask directions if possible from individuals in authority.
7.
Use banks and authorized money exchanges. Do not exchange on the black market or on the streets. Learn currency prior to your arrival in a country. This will keep you from being a target as you use money.
24

Operators are available 24 hours/day, 7 days/week
Campus Safety will contact the appropriate college personnel to assist you.
For international travelers: United States Department of State – 202-501-4444
1.
Share faculty/staff leader contact phone numbers with students.
2.
Create an emergency plan.
3.
Choose a designated student to know the emergency plan in case you are not available.
4.
Convey the local emergency number(s).
5.
Obtain student cell phone numbers.
6.
Create a communication tree for students.
7.
Implement the buddy system.
8.
Advise students to never leave their residence without ID or money.
9.
Designate a primary meeting place.
10.
Designate a secondary meeting place.
Course of Action
1.
The Hope faculty/staff leader or on-site coordinator (or designated student, in case of incapacity of the faculty/staff leader or on-site coordinator) contacts the appropriate local authorities (police, U.S. Embassy, medical personnel) to begin the location action necessary to handle the situation.
2.
The Hope faculty/staff leader or on-site coordinator (or student) contacts Hope College
Campus Safety to report the incident: 616-395-7770. Campus Safety then contacts the appropriate college personnel.
3.
The Hope faculty/staff leader or on-site coordinator (or student) should keep a written record of the incident(s), noting the date, time, place, and other details including witnesses and response. The incident record form can be found on the R&R website.
Specific Emergency Situations:
Seriously Ill or Injured Student or Faculty/Staff Leader
1.
The College will contact the student’s or faculty/staff leader’s designated emergency contact(s).
2.
Appropriate college personnel will be contacted.
3.
Necessary actions will be taken, including provision for essential medical care incountry, emergency evacuation, etc.
4.
The college will, if necessary, make funds available to cover emergency costs. Such expenses are the responsibility of the student or faculty/staff leader, but the college will advance funds as needed to assure a timely solution of the situation.
5.
If necessary, the college will make funds and staff available to ensure adequate group supervision and continuation of the program.
25

Death of Student or Faculty/Staff Leader
1.
The college will contact the student’s or faculty/staff leaders’ designated emergency contact(s).
2.
Appropriate college personnel will be contacted, as well as the college’s legal counsel.
3.
Counseling and psychological Services will be notified to provide counseling for other members of the group.
Student or Faculty/Staff leader with Emotional or Psychological Problems
1.
The college will contact the student’s or faculty/staff leader’s designated emergency contact(s).
2.
Counseling and Psychological Services will be in touch with the student, faculty/staff leader or on-site coordinator to evaluate the situation and make necessary recommendations.
3.
Appropriate college personnel will be involved as necessary.
Student or Faculty/Staff Leader is a Victim of a Crime or is Accused of Committing a Crime
1.
The college will contact the student’s or faculty/staff leader’s designated emergency contact(s).
2.
Appropriate college personnel will be contacted.
3.
If a sexual incident is between two student members of the group or a student member and a faculty/staff leader, the chair of the Sexual Harassment Policy Advocates will be notified and college policy will apply.
4.
If the incident is between a member of a group and an outside party, action taken will depend on legal requirements of the host country and the wished of the group member.
5.
The college’s legal counsel will be contacted, if necessary, for appropriate advice.
6.
If necessary, the college will contact local on-site authorities for appropriate action.
Situation that Causes Serious Concern (Political Uprising or Natural Disaster)
1.
The college will contact the faculty/staff leader or on-site coordinator for preliminary assessment.
2.
The college will contact the U.S. Department of State to receive the latest public announcements or travel warnings.
3.
The college will take necessary action based on advice from the U.S. Department of
State and on-site coordinators. This could be evacuation, moving to an embassy compound, remaining on-site and maintaining low profile or quarantine.
4.
When the status of the group has been accurately determined, the college, in cooperation with the on-site coordinator or faculty/staff leader will disseminate the information to appropriate parties.
26







27

To Caller: Please have as much of this information available and relay it to the dispatcher. Hope College
Campus Safety can be reached 24 hours per day at 616-395-7770 or 616-395-7000 .
International Call - 8-011+Country code+City+code+phone number
To Dispatcher: Collect as much information as possible from the caller. Keep on the line, DO NOT HANG
UP until necessary. Reference available information on R&R Moodle site. Contact Chad Wolters and
Dean Richard Frost immediately.
STAY ON THE LINE – MORE DETAILS ARE ALWAYS BETTER!
Date ________ Time _________
Who is calling? __________________________________________________________
Contact Information (call back number) _____________________________________
Cell Phone or Land Line Phone? ____________________________________________
Current Location (is it safe?)________________________________________________
________________________________________________________________________
________________________________________________________________________
Include Country/State, City, and Address or nearest intersection (if possible), Building, Room numbers.
Exact Nature of the Situation/Incident _________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Account for people in group – Is the group together? Separated? People missing?
Who is missing? __________________________________________________________
If missing unknown, who is there? ___________________________________________
_______________________________________________________________________
Any injuries? Other problems?
Immediate needs? _________________________________________________________
________________________________________________________________________
PLAN- Future Contact Information (phone number, location) ______________________
_______________________________________________________________________
_______________________________________________________________________
When will you make contact again? __________________________________________
INCLUDE ANY OTHER NECESSARY INFORMATION ON THE BACK OF THE SHEET
When you have all the necessary information contact the Dean of Students, Richard Frost via Phone let him know the nature of the call. Follow up with an e-mail to Richard also contact Chad Wolters and
Carol DeJong letting them know that you have sent them an e-mail.
NOTE: Copy pubsafe for our records
28

Hope College Campus Safety (24 hours/day, 7 days/week)
Tel: (616) 395-7770
Fax: (616) 395-7768
U.S. Department of State
Main switchboard: (202) 647-4000
Overseas Citizens Services: (888) 407-4747 OR (202) 501-4444 from overseas for answers related to questions concerning the:
 Death of an American citizen abroad
 Arrest/detention of an American citizen abroad
 Robbery of an American citizen abroad
 American citizen missing abroad
 Crisis abroad involving American citizens
 After-hours number for an emergency involving an American citizen abroad
Emergency Evacuation/Repatriation
 International Student Identity Card Insurance Desk o For students, faculty/staff leaders with the International student/Teacher ID card (ISIC/ITIC)
 Inside U.S. 7 Canada (877) 370-4742
 Collect from anywhere else (713) 342-4104
 iNext Worldwide Assistance Service o For those with the iNext Travel Card
 Inside U.S. (866) 385-4839
 Collect from anywhere else (715) 295-5452
29