(Continuing and Global Education Use Only)
 Fall
Class No.
FACULTY-LED SHORT-TERM
INTERNATIONAL TRAVEL STUDY
PROGRAM PROPOSAL FORM
(Complete front and back of form—
incomplete forms will be returned)
(Continuing and Global Education Use Only)
Year______________
 Summer  Spring
Class Section
Event ID
________________ ________________ ________________
________________
________________ ________________
Lecture
Lab/ACT
Tuition Fee $______________ Course Fee $______________
Note: Refer to the Faculty Handbook for detailed information on the
deadlines for submission, approval process and instructions on how
to complete the proposal. The Handbook can be found at:
http://www.fresnostate.edu/cge/international/travel/studytours.html
Program Title:__________________________________________________________________________________________________
Catalog Course Title:_____________________________________________ Units____________________________________________
Comprehensive Course Dates:________________________________________ to____________________________________________
On-Campus Course Dates:__________________________________Travel Dates:____________________________________________
Host Country and City Location(s):__________________________________________________________________________________
Deadline for Students to Apply for the Program (if known):________________________________________________________________
Program Pre-Requisites (Check As Many As Appropriate) p Same as Course Catalog:__________________ _p Instructor Permission
p Specific Course Pre-Requisites: ________________________________ p Other:_________________________________________
Enrollment Minimum ____________ Maximum ____________
Classnotes: p 15 (Web-Enhanced) p 17 (Web-Based) Other___________________
Topics courses only: Grading Method (check one): p Mixed
Will this class be team taught?

No

p Letter Only
Yes (If yes, please complete “Instructor #2 Information” section below)
Is this your first time signing up with California State University, Fresno Payroll Services?
Faculty
p Credit/No-Credit Only
Leader Information
 , we will inform you of the next steps
 No, list date of last appointment_________________________
Instructor's Name: ______________________________________________________________________________________________________________
Last
First
Middle Initial (Needed for Payroll Purposes)
Highest Degree Held:_______________________________________________ E-mail Address:_______________________________________________
Home Address:________________________________________________________________________________________________________________
Street
City
State
Zip Code
Fresno State ID:___________________________________________ Telephone:___________________________________________________________
(Office) (Other)
Campus Department (if applicable):_____________________________________________Mail Stop___________________________________________
Financial Eligibility: (Please indicate below if you are receiving compensation from the sources listed during the semester(s) in which this class is scheduled.)
Foundation or Auxiliary Sources (Including Grants and Contracts):  No  Yes ____________hours
Other Stipends (Sources May Include Department Chair, CSALT, Provost, College, etc.):  No  Yes ____________hours
Any Other State of California Compensation?  No  Yes _______hours. Are You On the Faculty Early Retirement Program (FERP)?    No
FOR OFFICIAL USE ONLY – TO BE COMPLETED BY DEPARTMENT STAFF Signature_________________________________ Extn _______________
Instructor Rank: (please check one)  Professor  Associate Professor  Assistant Professor  Teaching Associate
 Lecturer D
 Lecturer C
 Lecturer B  Lecturer A  Lecturer L
 Volunteer (volunteer form attached)
Is this your first time signing up with California State University, Fresno Payroll Services?
Instructor
#2 Information
 , we will inform you of the next steps
 No, list date of last appointment_________________________
Instructor’s Name: ______________________________________________________________________________________________________________
Last
First
Middle Initial (Needed for Payroll Purposes)
Highest Degree Held:_______________________________________________ E-mail Address:_______________________________________________
Home Address:________________________________________________________________________________________________________________
Street
City
State
Zip Code
Fresno State ID:___________________________________________ Telephone:___________________________________________________________
(Office) (Other)
Campus Department (if applicable):_____________________________________________Mail Stop___________________________________________
Financial Eligibility: (Please indicate below if you are receiving compensation from the sources listed during the semester(s) in which this class is scheduled.)
Foundation or Auxiliary Sources (Including Grants and Contracts):  No  Yes ____________hours
Other Stipends (Sources May Include Department Chair, CSALT, Provost, College, etc.):  No  Yes ____________hours
Any Other State of California Compensation?  No  Yes _______hours. Are You On the Faculty Early Retirement Program (FERP)?    No
FOR OFFICIAL USE ONLY – TO BE COMPLETED BY DEPARTMENT STAFF Signature_________________________________ Extn _______________
Instructor Rank: (please check one)  Professor  Associate Professor  Assistant Professor  Teaching Associate
 Lecturer D
 Lecturer C
 Lecturer B  Lecturer A  Lecturer L
 Volunteer (volunteer form attached)
5/15
PROGRAM PROMOTION
Course Description for Promotional Materials (One Paragraph):
Target Audience:
How does the program fit into the department’s or school/college’s strategic plan with regard to efforts to promote
internationalization of the campus and the curriculum?
Describe the depth, quality, and uniqueness of the proposed project.
Provide examples of how Fresno State students will benefit from this trip (i.e., increased internationally related knowledge,
awareness and competencies.)
ADDITIONAL MATERIALS TO INCLUDE WITH PROGRAM PROPOSAL FORM
Supplemental Information :
Name any other organizations, schools, or government institutions involved in this study tour.
Describe school, grant or other funding applied for/awarded to this study tour:
Describe your planned risk management and emergency evacuation procedures.
What health and safety considerations have you accommodated?
How will your class location, excursions, transportation affect accessibility issues and how will you accommodate
student needs?
Describe your selection process for transportation providers.
Describe your housing location and selection process (housing security, host family screening process, etc.).
Describe the facilities available for research and teaching at the instructional location.
Provide information regarding non-student participants going on the study tour (family, other staff, etc.).
Initials:_____ I have completed and/or included the above supplemental information with this proposal.
NOTE TO FACULTY LEADER(S) AND ADDITIONAL FACULTY/STAFF LEADER(S)
Initials:_____ I understand that international travel is not permitted to any country on the U.S. State Department’s Travel Warning list or the
Chancellor’s Office high hazard list without approval of the Chancellor. It is the policy of CGE not to support Faculty Led International Travel
Study Programs to any such countries.
Initials:_____ Prior to submitting the proposal, I read and understand the proposal instructions that include information on
deadlines for submission, approval process, proposal instructions, etc.
Attach the following items to this proposal:
• Course Syllabus
• Detailed Daily Itinerary
• Names and Contact Information for Third Party Providers/Travel Agents
• Faculty and Student Budgets (Use Form in Faculty Handbook)
• Documented Price Quotes from Vendors
Initials:_____ If this proposal is accepted and the trip materializes, I agree to submit a two-page evaluation report that summarizes the
outcome of the project, within 30 days of its conclusion to: Division of Continuing and Global Education. Faculty remuneration will only be
released upon completion and approval of the report. Faculty will be required to make a presentation about their trip during International Education Week.
NOTE TO ACADEMIC DEPARTMENT AND SCHOOL/COLLEGE
It is expected that the academic department and school/college be prepared to provide a replacement Faculty Leader if the original Faculty
Leader is unable to lead the program for any reason.
APPROVAL SIGNATURES
Faculty Leader:_____________________________________________________________ Date:________________________________
Instructor #2:_______________________________________________________________ Date:________________________________
Approved by Department Chair:_______________________________________________ Date:________________________________
Approved by Dean of School/College___________________________________________ Date:________________________________
CGE Office Use Only
Date Proposal Received:_________________________________________________________
Coordinator______________________________________________________________ Date:_______________________________
Manager of Finance & Administration_________________________________________ Date:_______________________________
Dean____________________________________________________________________ Date:_______________________________