University of Wisconsin Oshkosh Office of International Education
Application to Offer a Group Study Away Program
Sponsoring
Unit/Department
Program Title
Include the full formal title for your program. It’s important that the title that OIE uses be the same as
the title used on all other web pages and marketing materials. Shorter is better!
in
(country name)
Program Description
This is the description that will be used on the web to promote your program. Your description should
capture the purpose of your program, should include an overview of what students will be engaged in
while abroad, and should be fun! OIE may make changes to the description and will submit to you for
your review prior to posting on-line.
Program Liaison to OIE
Name
Phone
Anticipated # of participants
Minimum
Language of Study
English
I hope to run this program
Program Dates
Are these dates flexible?
424-
Once
Email
@uwosh.edu
Maximum
and/or
Other
Yearly
st
Every
years
1 Choice Dates from
/
/
to
/
/
2nd Choice Dates from
/
/
to
/
/
YES
Office Location
NO
If yes, please explain.
Cooperating Partners
Is this program being offered in cooperation with an institution or individual abroad?
YES
NO
If yes,
Institution Name
Contact Name
Phone
Email
Fax
Web Address
Explain this institution’s responsibilities in offering this program:
Courses
Course Options
List existing courses only. If the course you intend to use is not an existing course, your department
must submit the course for formal approval through normal university channels prior to applying to use
the course abroad. UW Oshkosh Curriculum Policies and Procedures do not allow the use of a
contractual course, i.e. independent study or related readings, for an organized, off-campus course.
All student participants will be enrolled in all of the courses listed below.
Student participants will earn between
and
credits total and may choose from the
courses listed below.
A-C = COLS Programs Only
Course #
# of Credits
Instructor
A
B
C
INTRNTL 333
1
Lane Earns
n
n/a
n/a
/
a
Application for Faculty-Led Programs~page 2
A. # of formal classroom instructional hours delivered by the UW Oshkosh instructor (include hours
taught before, during and after your program)
B. # of on-site (but not in a formal classroom) instructional hours delivered by the UW Oshkosh
instructor
C. additional hours (non-instructional) which count toward the 14 hour minimum required per credit;
include field trips, volunteer experiences, homestay, or other relevant experience. Explain here
Pre-travel Class Dates
Students expect to meet group members and their program leader or program advisor in a formal group
setting at least once prior to travel. In addition to offering course content, use this time to answer
questions, provide additional orientation, walk through travel itineraries, etc.
OIE has no required minimum or maximum number of sessions; check with your department chair
and/or College administration on requirements which may be specific to your unit.
Students are expected to ensure, prior to confirming participation on a study abroad program, that they
have no work or other obligations during your pre-travel class dates. Students with obligations during
one or more dates/times must disclose this on their application and must have the approval of the
program leader to participate before the OIE will place the student on the program. Once we advertise
these dates to students as mandatory, the dates shouldn’t be changed!
Day of the Week
Date
Time
Location
Application for Faculty-Led Programs~page 3
Is attendance required at all
pre-travel sessions?
Eligibility
Yes
No
If no, please explain:
What course and program eligibility requirements must students meet in order to participate?
Class standing
Minimum G.P.A.
(minimum may not be lower than 2.0)
Course prerequisites (list course numbers only)
Admission to (program of study)
Foreign Language Requirements
Interview with Program Leader/s
Recommendation Forms (# of forms:
)
Other (list additional selection criteria here:
)
The Dean of Students Office will also conduct academic misconduct and disciplinary background checks
and may make recommendations on terms of participation.
*No additional criteria may be used to determine course or program eligibility beyond what has been
approved through this application.
Student Accommodation
Choose from one or more of the following options for student accommodation.
*Homestays may only be arranged by licensed, insured organizations with formal policies and
procedures in place for screening, orienting, evaluating and removing host families from their program.
Homestay/Host Family*
Hostel
Residence Hall
Hotel
Apartment
Other
Required amenities (if any):
Maximum distance from program site:
max # of minutes
by
(type of transportation)
If you have already identified accommodation, provide the:
Name of the hotel
or company/organization providing the accommodation
Web address
Contact Information
Program Leader
Accommodation
Choose one of the following options for program leader accommodation.
Same accommodation as students
Different accommodation from students (please explain)
Resources Abroad
Describe your needs in relation to each of the following:
Teaching Facilities, including necessary AV and other equipment.
n/a or explain specific needs here:
Guest Lecturers
n/a or explain specific needs here:
Academic Programming
n/a or explain specific needs here:
Cultural programming
n/a or explain specific needs here:
Application for Faculty-Led Programs~page 4
Health & Safety
List cities & countries you plan to visit:
(city),
(city),
(city),
(city),
(country)
(country)
(country)
(country)
(city),
(city),
(city),
(city),
(country)
(country)
(country)
(country)
Read the US Department of State Country-specific Information for each country listed above (accessible
from http://www.travel.state.gov/).
List the precautions you will incorporate into your orientation and explain how you will take
recommended precautions into consideration while developing your program. If you aren’t sure, contact
the OIE Director for more direction.
(country): my orientation will include
(country): my orientation will include
(country): my orientation will include
(country): my orientation will include
(country): my orientation will include
(country): my orientation will include
(country): my orientation will include
(country): my orientation will include
Program Administration
; programming will include
; programming will include
; programming will include
; programming will include
; programming will include
; programming will include
; programming will include
; programming will include
As the Program Leader and Liaison to the OIE, I agree to take on the following responsibilities or assign
the following responsibilities to a second instructor or assistant in addition to responsibilities related to
the academic program. I understand that I am responsible for oversight of any assigned responsibilities.
Fill in the name/s of the program leader and additional instructor/s or assistant/s. Then, check items as
appropriate to each person for your specific program; items already checked are applicable to all
programs. Items which don’t apply can be left blank. If responsibilities are shared, check the box in
each of the appropriate columns.
Liaison
OPL
Name
OPCL
Name
OPCL
Name
OPCL
Name
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Name
review the Orientation Guide
actively participate in the development of the program
& respond to OIE questions and discussion items in a
timely manner;
schedule speakers, presenters and others who may be
part of the academic program abroad as necessary
when the program leader has established contacts; if
the professor/unit does not have the necessary contacts,
the OIE can contract this out;
schedule internships, volunteer work, job shadow
experiences, research opportunities, field work, etc. as
necessary when the program leader has established
contacts; if the professor/unit does not have the
necessary contacts, the OIE can contract this out;
market the program over at least one full semester prior
to the study abroad application deadline by, at a
minimum, 1) visiting classrooms, 2) distributing flyers,
3) attending study abroad fairs (or finding someone
else to represent the program at study abroad fairs), 4)
and soliciting the help of others in the department to
announce programs in classes and distribute flyers;
correspond with students regarding all academic issues
related to the program;
approve/deny student applications to the program
Application for Faculty-Led Programs~page 5
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Participants
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(optional for most programs);
develop/offer at least one pre-travel session to prepare
confirmed participants for the experience abroad;
attend program leader orientation prior to every
program offering, including training on emergency
responses and crisis management;
select/purchase gifts for contacts abroad (optional, but
must be budgeted!);
provide an in-country orientation;
remain responsible for and available to participants for
the duration of the program abroad;
respond to participant emergencies/crises in accordance
with UW Oshkosh emergency management plans;
promptly report inappropriate student behavior in
accordance with emergency management plans;
monitor group dynamics and activities and, if feasible,
intervene as needed;
participate in all planned group activities (the program
itinerary may include one or more pre-approved
activities which require student participation only);
manage money allocated through a travel advance in
relation to anticipated expenses while abroad and
account for these expenses (program leader will
manage group expenses and all others will manage
personal expenses);
serve as instructor-of-record;
send thank you’s to hosts, speakers, tour guides,
presenters, etc. involved with the program, or assigns
these notes to participants;
meet with OIE staff after the each program to complete
a formal, in-person program assessment.
Other
Other
Other
Other
Other
You must indicate your intention to apply to bring UW Oshkosh faculty and staff who are not officially
leading or co-leading a study abroad/away program and/or spouses, partners and dependent children of
UW Oshkosh study away/abroad program leaders or co-leaders here.
OIE will hold space on the program based on this application.
No faculty or staff who are not officially leading or co-leading a study abroad/away program and/or
spouses, partners or dependent children will apply to this program.
Faculty and/or staff who are not officially leading or co-leading a study abroad/away program and/or
spouses, partners or dependent children will apply.
List the name, relationship to you or to UW Oshkosh, and age (if under 18) of each individual
who will apply to participate (or on whose behalf you will apply):
I understand that participation may not be approved, especially in the case of minor
children.
I understand that in addition to indicating an intention to apply on this form, any faculty or
staff who are not officially leading or co-leading a study abroad/away program and/or spouses,
partners or dependent children must have a completed application on file BY NO LATER
Application for Faculty-Led Programs~page 6
THAN THE STEP II DEADLINE FOR THIS PROGRAM. The application form is available
from the “staff” “forms” pages on the OIE website.
I understand that when curriculum or logistics necessitate a maximum number of
participants, UW Oshkosh students, other UW System students, students from other U.S.
institutions and UW Oshkosh faculty and staff traveling for professional development purposes
have priority over non-students when assigning space in a study abroad program.
Friends and parents may participate as community members, if approved by the Liaison, and follow the
same application procedure and fee structure as university students. Spouses, partners and dependent
children taking one or more of the courses offered abroad for credit must apply as students.
Salary
COMPLETE THIS SECTION BEFORE OBTAINING SIGNATURES
Speak with your department chair or your unit’s budget manager to determine how much of each
instructor’s salary is to be covered by students through the OIE. Do not include salary dollars covered
by the college or co-leaders who are not teaching. Include only salaries; fringes are calculated by the
OIE.
Program Leader
Courses
Payment Method
Salary Contribution by Students
Part of Load – no replacement costs
$0
Part of Load – replacement costs paid to college $
per credit x
credits = $
PLUS
% of salary in fringe benefits
Overload
% per credit x
credits = $
Lump sum payment
$
Salary is paid directly by partners abroad
$0
Are you applying for a promotion which will affect your base salary?
YES
NO
2nd Instructor or Assistant
Courses
Payment Method
Salary Contribution by Students
Part of Load – no replacement costs
$0
Part of Load – replacement costs paid to college $
per credit x
credits = $
PLUS
% of salary in fringe benefits
Overload
% per credit x
credits = $
Lump sum payment
$
Salary is paid directly by partners abroad
$0
Are you applying for a promotion which will affect your base salary?
YES
NO
3rd Instructor
Courses
Payment Method
Salary Contribution by Students
Part of Load – no replacement costs
$0
Part of Load – replacement costs paid to college $
per credit x
credits = $
PLUS
% of salary in fringe benefits
Overload
% per credit x
credits = $
Lump sum payment
$
Salary is paid directly by partners abroad
$0
Are you applying for a promotion which will affect your base salary?
YES
NO
4th Instructor
Courses
Payment Method
Salary Contribution by Students
Part of Load – no replacement costs
$0
Part of Load – replacement costs paid to college $
per credit x
credits = $
PLUS
% of salary in fringe benefits
Application for Faculty-Led Programs~page 7
Overload
Lump sum payment
Salary is paid directly by partners abroad
% per credit x
Are you applying for a promotion which will affect your base salary?
Contributions
YES
NO
List all costs, except salary, which will be covered directly by a College, Department or grant, if
applicable. If the College, Department or grant will contribute a lump sum amount not associated with a
particular item, write, for example, “lump sum grant contribution” and then include the approved
amount.
Item
Item
Item
Item
Item
Attachments
credits = $
$
$0
Estimated $
Estimated $
Estimated $
Estimated $
Estimated $
Account to be charged:
Account to be charged:
Account to be charged:
Account to be charged:
Account to be charged:
The following may also be required for approval at the department and/or College level. Check the
boxes to indicate which attachments are included in this proposal.
The academic objectives of the program, including how these objectives relate to the unit’s
goals, how the program will fulfill these objectives and a statement explaining why it is
important that this program be offered in the proposed location.
The course syllabus, including reading, research and/or project requirements, the topical
content of pre/post-departure academic sessions, etc.
Official course descriptions for courses offered through another institution.
Justification for academic program features.
Student evaluation procedures (academic).
Itinerary Submission Date:
Itinerary Last Updated:
On-site Program Leader (OPL) and On-site Program Co-Leader (OPCL) Name(s):
Program Name:
Program Dates:
Minimum/Maximum number of students:
Update dates (color code by date and new content):
*Classroom Hours: Indicate the total number of classroom hours you’ll need on a particular date in this column. Also indicate whether you will need traditional
classroom space and all equipment which may be necessary. If traditional classroom space is not needed (i.e. class can be held informally in a public area) please indicate
this in the “classroom hours” column.
**Responsible Party:
OPL/OPCL = Program Leaders;
TA =Travel Agency/3rd party provider;
OIE = UWO Office of Intl Ed
***Transportation: may include walking, public transport (i.e. bus/subway, train, air), private coach, etc.
Day/
Date
Classr
oom
Hours
& AV
Needs
*
/
/
/
/
Location:
Daily Itinerary Description:
Responsible
Party**
Transportation***
School bus from UW Oshkosh Parking Lot 6 to Chicago O’Hare
OIE
Bus
Flight
OIE
Air
Misc. Notes
Application for Faculty-Led Programs~page 9
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Application for Faculty-Led Programs~page 10
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Do you need additional
rows? Contact the OIE for a
form with a longer itinerary.
Signatures
The Liaison to the OIE must obtain the signatures of the appropriate Department Chair/s, the
Dean and, for USP courses, the USP coordinator, before forwarding this form to the OIE. Where
the signature of a Chair is required, the Chair of the Department under which the course is listed or the
person responsible for curriculum within the college must sign. If the course is cross-listed, both
Department Chairs must sign.
Your signature on this form indicates your approval
 to run this study abroad program one time only. A new application form must be circulated
for approval each time that this program is proposed. However, the OIE will keep all programs
which faculty indicate will be run more than once on the OIE directory and will advertise them as
standing programs. These programs will be cancelled if not approved at all levels.
 of the level of Academic Quality of the study abroad program (with the exception of the OIE
Director, who does not assess or approve academic quality).
You will be asked to sign this form again if the Liaison to the OIE makes significant changes to the
itinerary. Changes may need to be made due to budgetary restraints, opening/closing of venues or other
factors.
________
Date
________________________________________________________________________
Liaison to the OIE
____________ ________________________________________________________________________
Date
Chair
Department
Related Course #
____________ ________________________________________________________________________
Date
Chair
Department
Related Course #
____________ ________________________________________________________________________
Date
Chair
Department
Related Course #
____________ ________________________________________________________________________
Date
Chair
Department
Related Course #
____________ ________________________________________________________________________
Date
University Studies Program (for courses that meet USP requirements only)
___________ ________________________________________________________________________
Date
Dean
College
___________ ________________________________________________________________________
Date
Dean
College
____________ ________________________________________________________________________
Date
Office of International Education Director
OIE Comments
____________ ________________________________________________________________________
Date
Provost & Vice Chancellor