Application for Independent International Projects
and Non-UWSP Study Abroad Programs
Attach payment to this form. See details on following pages. If you require financial aid
to participate in the program, pay close attention to the Financial Aid questions below!
UWSP ID #:
Name:
Birth Date:
Passport #:
Campus Address:
Campus Phone:
Home address:
Home Phone:
Current Academic Status (Level/Year in College):
Minor:
Major:
State of Residency (WI, MN, Other):
Cumulative GPA:
Do you receive Financial Aid at UWSP?
Are you working with the UWSP Financial Aid Office on a Consortium Agreement?
yes
no
yes
no
Have you signed up for Electronic Deposit of your financial aid refund? If not, this can be done on the Bursar’s website:
http://www.uwsp.edu/admin/busaffairs/bursar/financial_aid.aspx
Official Program Title and Location:
Academic Term, Beginning and End Dates:
Official Sponsor Organization:
University/Sponsor Address:
University/Sponsor Telephone:
University/Sponsor Contact Person:
Office Use Only:
Initial Fee Payment
Passport & Visa Copy
Course Registration &
Dept. Approvals
Authorization Forms Completed
Insurance Enrollment or Proof of Insurance
Departure Workshop
Materials
S:\StuStaff\Office Forms\Application Forms\Non UWSP Study Abroad and Independent UWSP Study Application.docx
Revised: 1/28/2016
Who needs to complete this form?
Any continuing students who intend to complete a UWSP degree and plan to . . .
•
study abroad through another accredited U.S. private or public university or a third-party study abroad provider*
and want the academic credit applied to a UWSP degree program.
OR
•
study abroad through another accredited U.S. private or public university or a third-party study abroad provider*,
and want to use Financial Aid for the study abroad experience.
OR
•
undertake an international project under the guidance of a UWSP faculty member completely separate from an
official UWSP study abroad program. This includes projects for which a faculty member has agreed to grant
academic credit either as independent study or as internship credit. NOTE: The faculty member needs to contact
the Study Abroad Director as soon as possible to clarify the faculty member’s responsibilities and liability in
arranging such independent academic work separate from university facilities. The Office of International
Education will work with the appropriate UWSP academic departments for course approvals and registration.
*A third-party provider is a private organization that arranges academic study abroad programs for universities BUT is not
directly affiliated with UWSP and does not have an agreement with the University to provide UWSP course credit. These
programs require prior approval to grant UWSP credit for the courses taken through the provider. Speak with the program’s
contact person and then set up a meeting with the UWSP Study Abroad Director.
By completing this form and its related requirements, you will remain an active UWSP student for admissions purposes,
registration of classes, and financial aid eligibility. Your UWSP email and MyPoint accounts remain active.
Required Signatures and Authorizations

ADVISOR ACKNOWLEDGEMENT: The student and I have discussed the study abroad academic
plan, and I support the student’s decision to pursue this study abroad opportunity.
Academic Advisor's Signature

Date
STUDENT STATEMENT OF INTENT: I have discussed my study abroad plans with my academic
advisor. I have also read and understood the “Payments, Fees and Insurance Information”
statement attached to this document.
Student Signature

PRINTED NAME
PRINTED NAME
Date
STUDY ABROAD DIRECTOR APPROVAL: I recommend that this student be enrolled in (circle and/or
fill in details of academic enrollment)
INTL 098 (semesters only)
INTL 391 for ______ credits.
OTHER: _________________________
Subtitle: ___________________________________________________
Instructor: _________________________________________________
Study Abroad Director
Date
Payments, Fees, and Insurance Information
Payment of an initial fee to the Office of International Education is required at the time you submit your completed
application. Program fees and any tuition costs will be assessed to your UWSP billing account. As soon as possible,
meet with the Study Abroad Director to determine how payments will be arranged.
Work with the Study Abroad Director
to determine which one fits your chosen program.
Category One (Semester Abroad Only): Initial fee is $250. If the program provides an official course
transcript from an accredited U.S. university and accepts a financial aid consortium agreement with UWSP.
The Office of International Education will assess a tuition charge for INTL 098 enrollment as well as other
required fees beyond the initial $250 to your UWSP billing account according to the appropriate Academic Fee
Schedule based on UWSP residency status. If needed, the Office of International Education will also charge for
the required UW System insurance policy (see below).
Category Two (Any Academic Term): Initial fee is $500. If the program does not provide an official course
transcript from an accredited U.S. university OR does not accept a financial aid consortium agreement with
UWSP OR if you plan to receive UWSP academic credit for completing an independent project abroad,
including an internship.* The Office of International Education will assess tuition charges and fees for fulltime
enrollment to your UWSP billing account according to the appropriate Academic Fee Schedule based on your
official residency status. If needed, the Office of International Education will also charge for the required UW
System insurance policy (see below). Note: Only tuition funds will be applied to the program’s academic
costs (not any UWSP fees). Tuition and fees charged by program providers are often higher than full-time
Wisconsin resident tuition can cover. You will be billed for these additional costs accordingly.
*International internships or other independent projects: You will need to work with a UWSP faculty member
to determine how many credits will be awarded and how you will be evaluated for the work completed. The
Office of International Education will need a copy of the syllabus or project agreement from the cooperating
faculty member.
REQUIRED INSURANCE: If your program provides international travel/health insurance, the Office of International
Education will need proof of insurance. Submit a copy of your program’s insurance plan along with evidence of
enrollment. If your program does NOT include international travel insurance, UW-System has mandated the
purchase of a state-approved health insurance plan for all UW System students abroad. The policy is through CISI,
Cultural Insurance Services International. The cost is approximately $35.00 per month currently and will need to be
paid prior to your departure. You will be issued an insurance card upon receipt of payment. *If your study abroad
program is sponsored by a UW System institution, CISI insurance should be provided to you through that institution.
Please bring in verification so you can be waived from this requirement.