APPLICATION IS DUE: October 15, 2014
Liberty University
School of Education-Jamaica Trip
1971 University Boulevard
Lynchburg, VA 24502
Full Name:
Liberty University ID Number:
Age:
Gender:
Email Address:
Physical Address:
Phone Number:
Course Substitution (course on your DCP)
Please submit a copy of your passport with this application!
With this application, I agree to the following if I am approved for the trip:
A $200 non-refundable trip fee will be paid directly to the Cashier’s Office AFTER you have been
notified of your approval to participate in this program. This fee must be paid within one week of
your approval. The trip fee will be applied to the $600, and you will be responsible for the
remaining $400 balance to the Cashier’s Office. This will be due by March 29th.
Please write out the following statement before signing and dating this document:
“I will abide by the Liberty Way. Failure to do so will result in immediate dismissal from the
group. Flight arrangements will be made, and I will be responsible for the payment of the
return trip, if I am dismissed.”
SIGNATURE: ___________________________________
DATE: _______________