Greece 2016 Study Tour Application July 10th-­‐July 19th, 2016 Department of Psychology and Department of Social Work Email your completed application to psyc499intern@liberty.edu. Student ID#: _______________________ Participants may register and earn credit for one of the following courses in conjunction with the corresponding trip date. Standard tuition rates and fees will apply. Please select one of the following trip dates and the course you are interested in taking. Students may not take more than one 3 credit hour course during each 10-­‐day trip.
SOWK 439 – Intl. SOWK Field Experience* PSYC 499 – Psychology Internship** * Students are required to complete all prerequisites for ** Students are required to have a minimum of 18 PSYC this course prior to the start date. The prerequisites are credit hours before the start of a PSYC internship.
SOWK 101, SOWK 120. (SOWK 101 and 135 for LUO students)
Personal Information Last: __________________ First: _________________ MI: _______ Age: ______________ Preferred Name: Date of Birth (mm/dd/yyyy): / / Email: Phone (Home): (Mobile): Home Address: City/State/ZIP: Gender (M/F): Degree Pursuing: Have you been convicted of a felony? If so, please attach a written explanation. Marital Status: Number of Dependents: Spouse’s Name: Residential student: ________ or Online Student: __________ Classification: ________ Travel Information (Application can be submitted without a passport.) Do you have a valid passport? Country: Expiration Date: If No, have you applied for a passport? When? For more passport information go to http://travel.state.gov/passport/passport_1738.html
Email your completed application to psyc499intern@liberty.edu by Date and Destination of your most recent international travel: Payment Information: All payments will be made via an LU payment portal which will be provided upon acceptance *Students much purchase flight tickets that will have them arrive before 4pm on the first day of the trip, July 10th. Athens, Greece -­‐ The total cost for this trip is $1100, which covers the participant’s in-­‐
country transportation, basic meals (student will want to bring additional funds for snacks), lodging accommodations, museum tickets, air conditioned classroom space, an on-­‐site Resident Director, and their LU faculty member. This does not cover airfare or course tuition. Students will be required to plan and pay for their own travel to and from Athens. There are three deadline payments which are non-­‐refundable, please initial each line: Payment Deadline 1: March 25th: $300 Payment Deadline 2: April 22nd: $800 Passport Copy Deadline: April 22nd (color copy emailed to application email address) Emergency Information (REQUIRED) Emergency Contact #1 (Parent/Guardian/Spouse) Full Legal Name: Relationship: Address: City/State/ZIP: Telephone: home ( ) work ( ) mobile ( ) other ( ) Email Address: Emergency Contact #2 Full Legal Name: Relationship: Address: City/State/ZIP: Telephone: home ( ) work ( ) mobile ( ) other ( ) Email Address: Medical Information (REQUIRED) THE FOLLOWING INFORMATION WILL BE KEPT CONFIDENTIAL. IT IS GATHERED FOR THE OFFICE TO BE ABLE TO BETTER CARE FOR EACH INDIVIDUAL. PLEASE TAKE THE TIME TO ANSWER EACH QUESTION AND FILL OUT THE INFORMATION THOROUGHLY. Allergies Email your completed application to psyc499intern@liberty.edu by Foods: Drugs/Medication: Environmental Factors: Other: Medical History Current Medications (include over-­‐the-­‐counter medication, herbal products, birth-­‐control pills, etc.) Medication Dosage Reason for Taking The student is responsible for all medications that must be taken during the course of this international trip. Take care to bring the necessary medications in their original containers. Students must abide by and following The Liberty Way or Code of Honor while attending a university sponsored Study Tour. The Student Participation Agreement form is below. Please sign and date below stating that you have accurately completed this application and understand its requirements: Name: _______________________________________________ Date: _________________ Please provide a 300-­‐‑600 word response to the following questions. 1. Share how you came to know Christ as your Savior and how you are currently growing in your relationship with Him? 2. Describe a significant personal challenge you have faced, and explain how your faith helped you navigate this situation. 3. Considering your past experiences and practical skills, how might the team benefit from you? 4. What past experiences in your life might make this trip particularly challenging, and why? 5. Why do you want to participate in this particular trip? Specifically, what are your personal expectations and goals for going to Greece? Email your completed application to psyc499intern@liberty.edu by