(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:_______________________________