TEACHING BEYOND BORDERS
Daytona State College
HAITI PROJECT
Summer A 2014
Student Information and
Study Abroad Program Application
Welcome
Dear Daytona State College Student,
We are very pleased you have expressed interest in joining us for the Summer 2014
Teaching Beyond Borders expedition to Cap Haitien, Haiti. This is not your average study
abroad program (SAP) and will most likely be a very meaningful and life-changing experience.
This study abroad program is made possible through the cooperation and partnerships
of several non-profit organizations. Our sister school for this project is College Susan Schuenke,
which is a pre-K through grade 13 private Christian school located in Cap Haitien in the northern
region of Haiti. The College Susan Schuenke seeks to provide an education to over 800 children
of Cap Haitien living in poverty and is entirely supported by donations from individuals,
churches, schools, and corporations.
Vision of Hope Ministries (VOHM) has also agreed to help our endeavors by hosting us in
Berard, Haiti, a rural village about a half hour from the city of Cap Haitien. VOHM regularly
hosts groups to do work in Haiti and will provide us with knowledgeable guides and
interpreters. We are fortunate to be supported by Missionary Flights International (MFI), which
operates out of Fort Pierce, Florida, and is capable of flying us directly into Cap Haitien, thus
avoiding an arduous overland journey from Port Au Prince.
Enclosed you will find several documents required by Daytona State College, MFI, and
VOHM. Please complete these documents and return to Dr. May or Margie Hensler at your
earliest convenience. Your application will then be reviewed. Once you are approved you will
be given a clearance form to begin submitting payment for this SAP.
Space is limited, so it is very important your application be submitted in a timely
manner, you provide all needed documentation, and you complete payments as scheduled.
Place in class will be granted on first-come, first-served basis for those who complete the
application and receive clearance to submit payments.
Please see Dr. Donald May and/or Margie Hensler if you have any questions regarding
the SAP trip or the information in this packet. Thank you again, for expressing willingness to
join our endeavors in Haiti.
Sincerely,
Dr. Donald May
Associate Professor, College of Education
Daytona State College
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TABLE OF CONTENTS
Study Abroad Program Information
Overview of Study Abroad Program ……………………………………………………………
Purpose of Teaching Beyond Borders …………………………………………………………
Teaching Beyond Border Mission, Vision, and Values ………………………………..
Requirements for Acceptance to the Program …………………………………………..
Estimated Student Costs ……………………………………………………………………………
Schedule for Submitting Application and Payments ………………………………….
Accommodations and Meals ……………………………………………………………………..
Traveling Protocol ……………………………………………………………………………………..
Health Information ……………………………………………………………………………………
Clothing ……………………………………………………………………………………………………..
Packing for Your Trip ………………………………………………………………………………….
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Student Application Documents
Teaching Beyond Borders: Study Abroad Application …………………………………
Teacher Recommendation Form ………………………………………………………………..
Daytona State College Release Form …………………………………………………………..
Vision of Hope Ministries Release Form ……………………………………………………..
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Overview of Study Abroad Program
The purpose of the program is to create sustainable cross-cultural connections and servicelearning opportunities for the institution and you, the students of Daytona State College (DSC).
This project is part of a service-learning in education course EDG 2905 offered Summer A, 2014.
This program includes annual service-learning excursions to Haiti in which Daytona State
College students implement a project to meet the needs assessed by students the previous year
and then conduct a current needs assessment before returning to DSC. Upon returning to DSC,
students create presentations to communicate to stakeholders and sponsors regarding their
experiences and the current needs that should be addressed the following year. While in Haiti
you will benefit from the experiences of teaching English and providing other needed services
in the pre-K through grade 13 target school.
You will spend the first two weeks of the program in the classroom at Daytona State College
learning about the needs assessments conducted in the region the previous year and designing
a project to implement in Haiti in order to meet the identified needs. You will be instructed
how to teach English language learners and develop mini-lessons you can implement in the
field classrooms. You will also prepare by learning basic Haitian Creole language and greetings,
cultural norms, general characteristics of the region and inhabitants, and relevant historical
factors.
We will then travel to Cap Haitien, Haiti and spend time working with the staff and students of
College of Susan Schuenke. The majority of our time will be devoted to modeling best
practices, co-teaching lessons with the teachers, and interacting with and conducting special
events for the students. A few structured excursions will also be conducted because it is
important for you to see many diverse aspects of the Haitian culture. For instance, we will try
to see The Citadelle, the Cathedral Notre Dame de Cap Haitien, and visit with local leaders and
others who serve the needs of the community.
We will return to the DSC classroom for debriefing and finalizing projects. These multimedia
projects will be designed to communicate your personal experiences and educational growth
during the service-learning project and will be presented to stakeholders, sponsors, and the
greater DSC community.
The experience of study abroad travel, in general, always has an effect on all of us as we are
able to broaden our viewpoint by seeing another part of their world. However, being able to
contribute and make a difference during these same travels will create a lasting memory that
will most likely shape your outlook in the future.
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Purpose of Teaching Beyond Borders
The foundational belief of Teaching Beyond Borders is that education is the most powerful
force we can use to change our world. This belief drives us in the Teaching Beyond Borders
(TBB) program to diligently work to increase access to a quality education for all children,
especially those children who live in disadvantaged regions of the world like Haiti.
The conditions in Haiti continue to improve, but Haiti remains one of the countries with the
lowest school enrollment rates in the world. According to the recent Human Rights Watch
World Report, prior to the earthquake in 2010, only about half of primary school-age children in
Haiti attended school. In 2011, President Martelly introduced a plan for free universal primary
education. Yet, as of 2013, only 67 percent of children attend primary school and less than 30
percent of these children do not reach 6th grade. At the secondary level the enrollment figure
drops to 55 percent with less than 20 percent graduating. Many of these children do not pass
the Government exams and receive no accommodations to continue their schooling. The
literacy rate among adults and youth varies from 50 to 66 percent.
TBB seeks to change these trends by collaborating with teachers in Haiti to enhance teaching
and learning and to promote literacy. Teachers in Haiti face enormous challenges. Out of
approximately 60,000 teachers in Haiti, 84 percent are not qualified. Teachers also lack training
opportunities, materials and access to technology, as well as adequate remuneration.
TBB’s aim is to collaborate to better meet the needs of the Haitian students, to model good
teaching, and to inspire, support and value the work of our teacher colleagues. Through
Teachers-Teaching-Teachers workshops we share content and training ideas with fellow
teachers. We realize helping one Haitian teacher affects the education and lives of hundreds of
children.
Teaching Beyond Border Mission, Vision, and Values
The mission of Teaching Beyond Borders is to unite teachers in efforts to increase access to a
quality education, promote literacy, and better serve the needs of disadvantaged children.
Vision: Teaching Beyond Borders makes a difference in the lives of children by improving the
effectiveness of their education.
To fulfill carry out its mission and fulfill this vision the Teaching Beyond Borders program has
established the following values:
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Create sustainable cross-cultural connections
Provide increased access to a quality education
Embrace diversity and emphasize all students can learn
Promote literacy for the whole community
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Embrace excellence in teaching and foster innovation
Increasing Quality of Life - Haiti is undoubtedly the poorest country in the Western
Hemisphere, with a per capita income of $200 per year. Families are typically large, often with
six to eight children. Life expectancy is low, with one-third of children dying from malnutrition
or infection before age 5. An effective project must be holistic in its approach if we are to make
a difference in the lives of children and promote education. Sometimes our efforts may be
focused on feeding people in need, providing increased access to education for needy students,
supplying safe water, or offering micro-enterprise opportunities to willing workers. In most
cases our efforts go beyond the borders of the classroom.
Promoting Literacy – Most recent studies indicated only 52 percent of the Haitian people know
how to read or write. Young people have little hope of obtaining education or attending college
due to their bleak situations. To be contributing citizens and improve conditions in their
communities, they must be able to read. Therefore a majority of our energy will also focus on
supporting College Susan Schuenke and their efforts to address the problems of illiteracy in
young students.
Requirements for Acceptance to the Program
Students must have a cumulative GPA of 2.0 or higher and have teacher recommendation to be
considered for the study abroad program. Students must also obtain a valid passport and
consult a medical doctor regarding preventive health measures (see Health Information below).
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Estimated Student Costs
Teaching Beyond Borders
EDG 2905 Directed Study in Education Summer 2014
Item
Transportation
Type
Airfare
Description
Cost
MFI Airlines - Round trip from Fort Pierce, FL to Cap
$520
Haitien, Haiti
(includes baggage not to exceed 50 lbs)
Ground Round Trip to and from MFI Fort Pierce Airport
$80
Expenses for drivers while in Haiti
Accommodations
Covers all room and board fees while at housing
$400
compound in Berrard, Haiti (7 days)
Group Host Fees
Covers all guides and interpreters
$55
Entrance Fees
The Citadel (La Ferriere) and Cormier Plague (beach
$40
resort)
Program Fee
Covers travel insurance and international cell phone
$185
access
Trip Cost
$1280*
*Price is based on a minimum of 8 participants
Trip Cost does NOT include tuition for course; costs of obtaining passports, visas or tourist
cards; excess baggage fees over allotted 50 lbs ($1.50/lb); personal expenses such as shopping
at Tourist Market; laundry service; and all meals, beverages and gratuities while away from
Berrard housing compound (La Kay, Cormier Plague, and Hotel Mont Joli).
Additional Costs
Tuition
Approximate costs for 3 credit course ($104.48 per
credit hour). *This total is based on current tuition
rates and does not include other fees that may be
added by the College.
~$313.44*
Personal Expenses
*Personal expenses will vary. Students will need to
bring funds to cover personal expenses such as
shopping, laundry service, and all meals, beverages
and gratuities while away from the Berrard housing
compound (average prices for planned restaurant
visits: La Kay $12, Cormier Plague $25, and Hotel
Mont Joli $10).
~$200*
Estimated Total Trip Cost $1793.44
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Schedule for Submitting Application and Payments
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January 17, 2014 – Application and $80 deposit due
January 27, 2017 - $400 payment due
February 24, 2014 - $400 payment due
March 24, 2014 - $400 payment due and must provide evidence of valid passport
April 1, 2014 – register and pay for EDG 2905 class
Students may complete payments earlier or pay in lump sum. All Study Abroad Program
deposits and payments are refundable prior to March 24, 2014. After March 24, 2014 no
refunds will be provided.
Securing Your Place in the Program
The first ten students who submit their application with $80 deposit will secure their place in
the program. Up to five additional students may be placed on a waiting list. All students,
including those on the waiting list, must make payments as scheduled. Students who do not
make scheduled payments will lose their position in line, surrendering their seat to those
farther down the list.
Accommodations and Meals
We will be staying in the VOHM’s ministry home in Berard, a rural village about a half-hour
from the city of Cap-Haitien. This place, our base of operations, is equipped to host many
people at once. By Haitian standards, the house is considered quite luxurious, with generatorpowered electricity and indoor plumbing. By U.S. standards it is simple but reasonably clean
and modern. There is a guesthouse with bunk beds, bathrooms, toilets, sinks, and showers.
Please bring along a pillow, twin-sized sheets and an old towel that you can leave in Haiti at the
end of your trip.
We recommend that you bring a bodily insect repellent containing DEET
(diethylmethyltoluamide), in 30%–35% strength for adults (or 6%–10% for people with sensitive
skin). You may also wish to bring a can of Raid to be used to spray your sleeping quarters daily.
A mosquito net for sleeping under is also a must.
There are bathrooms with showers for groups to use. A well pumped by a generator supplies
the house with cold water (no hot water) for bathing. Showers should be kept short because
the water tank holds only 400 gallons, which does not go far for a house full of people. Get
wet, turn off the water, soap up, and then rinse off. When the water runs out, the generator
must be turned on to run the well pump to fill the tank again. Be sure not to drink the wellwater or even brush your teeth with it. Bring along a few mirrors so that some team members
can shave or comb their hair while others are in the bathroom.
Ladies, used sanitary items should be wrapped well and placed in a plastic bag and disposed of
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in the garbage outside the house regularly. Ask someone in the house where garbage should
be placed.
For your stay, you should bring Lysol or Clorox disinfecting wipes to maintain bathroom
cleanliness. Please set up a rotation for members of your group to take turns with
housekeeping duties to keep things in order each day.
A note on cleanliness: the best way to prevent the spread of germs and illness is to wash your
hands thoroughly, and often. The Haitian people are friendly and eager to shake hands with
visitors. Be careful not to touch your face, especially your mouth, nose and eyes. Carry
waterless antibacterial soap with you, and use it throughout the day. Simple, frequent hand
washing easily prevents even cholera.
Your team should not invite neighborhood children or adults (even those attending services on
the grounds) into the ministry house at any time. We are careful to keep the house secure and
lock doors as is appropriate, but Vision of Hope Ministries accepts no responsibility for your
personal belongings. Be mindful of your valuables including cameras, wallets, passports,
money, camcorders and so on. We advise that your passport and entry card to the country be
kept on your person.
Wonderful cooks are employed who will prepare and serve your meals every day. Typical foods
served include rice and beans, eggs, turkey or chicken, goat (watch out for sharp bones), hot
dogs, meatballs, macaroni and cheese, lasagna, bread, oatmeal, french fries and seasonal fruits
and vegetables. Safe, bottled water from a Culligan plant is readily available.
In Haiti you won’t be able to visit a grocery or convenience store, so plan ahead by bringing
snacks with you. Suggestions are crackers or cookies, pre-wrapped snacks, dried fruit, trail mix,
candy that does not melt, peanut butter. Be sure to bring a plastic container with a tight fitting
lid to store these in. A water bottle to be filled each day is indispensable.
Traveling Protocol
Handling Your Luggage and Travel Documents
It is recommended that you make two copies of your passport and any identification you may
carry. Leave one copy with someone in the US and take the second copy with you, but keep it
in a place separate from where you will keep the original documents. This can be very helpful
in the event that a document is lost.
Your luggage will be inspected by customs officials upon arrival in Haiti, as part of airport
procedure. Be polite and cooperative and do not joke around with them. If you are provided a
luggage claim check, make sure you have this handy as you de-plane. Upon arrival in Haiti,
locals may ask for your claim check or reach for your luggage in an effort to help you - in return
for a tip. It is best to refuse their assistance and handle the claiming of your luggage by
yourself.
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How To Handle Solicitations
Be prepared for children approaching you, begging for a dollar. You should refuse in order to
avoid drawing a crowd or putting yourself at risk. In many places we will visit there are people
who commonly panhandle and guards to keep solicitors away. It is important you follow
protocol and do not create a commotion.
While in Haiti, many people – especially children – may approach you and explain their
hardships. What you should realize is that when Americans are visiting Cap Haitien,
neighborhood children will frequently show up in an effort to get handouts. The needs in Haiti
are certainly great, but please do not hand out anything without first discussing doing so with
our host, Henoc Lucien. Those with true needs are always directed to speak with church
leaders, who are given a special fund every month from Vision of Hope to distribute to families
in distress. If you have a question or concern, please ask Mr. Lucien.
We do not recommend that you give your address or telephone number to anyone. This only
will invite solicitation letters and, in some cases, collect phone calls from Haiti with requests for
your money. The best way to help the people in Haiti is to give to an established non-profit
organization which is organized to help people on a widespread basis and is set up to handle
individual crisis situations as they arise. If you have questions about a particular situation while
in Haiti, Mr. Lucien is the best resource for answers.
Health Information
There are no specific immunization requirements for entry into Haiti. Of course, there are basic
immunizations that every traveler should have, including tetanus, measles, mumps, rubella and
polio.
The National Center for Infectious Diseases offers excellent advice regarding travelers’ health.
Please visit the CDC website: http://wwwnc.cdc.gov/travel to find information relevant to travel
in Haiti. Select “For Travelers,” scroll to find “Haiti,” select “Extended Stay / Study Abroad,” and
then click “Go.”
To be prepared for the health risks in Haiti, we formally ask that you make a visit to your
medical doctor and inform him/her of your travel plans and discuss recommended precautions.
Inform him/her that you will be staying in a rural area in northern Haiti but will be traveling to a
more urban city often. You will not be handling livestock or working in a medical care capacity.
He or she may recommend the following:
For All Travelers
Routine Vaccinations: Make sure you are up-to-date on routine or standard childhood vaccines.
These vaccines include measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis
vaccine (make sure you have had a tetanus vaccine in the last five years), varicella (chickenpox)
vaccine, polio vaccine, and your yearly flu shot.
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For Most Travelers (discuss with your doctor)
Hepatitis A - CDC recommends this vaccine because you can get hepatitis A through
contaminated food or water in Haiti, regardless of where you are eating or staying.
Immunization series includes two shots six months apart. (Not for most travelers, but may also
discuss with your doctor the need for hepatitis B immunization series of three shots two and
four months apart.)
Malaria - You will need to take prescription medicine before, during, and after your trip to
prevent malaria. Your doctor can help you decide which medicine is right for you, and also talk
to you about other steps you can take to prevent malaria. See more detailed information about
malaria in Haiti. The National Center for Infectious Diseases states “Travelers to all areas of
Haiti are at risk for malaria.” As of January 2006 their recommendation was to take
chloroquine or hydroxychloroquine sulfate to prevent malaria in Haiti.
Typhoid - You can get typhoid through contaminated food or water in Haiti. CDC recommends
this vaccine for most travelers if you are staying with friends or relatives, visiting smaller cities
or rural areas, or if you are an adventurous eater.
Cholera has also been present in Haiti for the past few years. Be sure to discuss this with your
medical professional. The very best defense against cholera is simple, frequent hand washing.
Check with your local county health department to see whether they offer vaccinations, which
will be less expensive than receiving them from your doctor. If you begin the Hepatitis A and B
vaccination series but are not able to complete them due to a lack of time before your trip, you
can count on at least some degree of protection. Your health care provider is the best source of
advice on the matter of immunizations.
Be sure to bring medication for common ailments such as headache, diarrhea, constipation and
nausea, as such things are difficult to come by in Haiti. Carry your personal medications in their
original containers. Keep them with you as you travel in case the airlines lose your luggage. Be
sure you have an adequate supply for the duration of your trip.
In case of emergency, medical care is available in Cap Haitien and in Milot (near the ministry
house) through private hospitals run by missionary groups. However, these hospitals may not
always be easily accessed depending on where you are. Exercise care and your best judgment
at all times to help prevent accidents and injury.
Clothing
The weather will be hot and humid, so be sure that your clothing is lightweight yet durable and
appropriate for your various activities during your trip. The Haitian people are modest in their
dress and we ask that you dress likewise. Here are our suggestions for your wardrobe:
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Wear lightweight, light-colored clothing. Sports fabric blends and cotton are the best fabrics for
breathability. Aim for comfort, not for style. Shop for your trip at thrift stores and yard sales
and clean out your closets. Many times we leave our clothing behind in Haiti at the end of our
trip.
Most Haitian women wear dresses every day, but team members can also wear lightweight
pants and modest, longer shorts / capris. When we are at school while classes are in session we
should dress in school-appropriate clothing (business casual – collared shirts, pants, dresses,
etc.) as we would for schools here in the U.S. When classes are not in session and we are doing
manual labor at the school we may wear plain T-shirts without flashy or questionable
advertising and shorts. Sleeveless dresses and blouses are suitable for ladies, but please do not
wear fitted tank tops, particularly those with spaghetti straps.
We should try to blend-in as much as possible and match the level of Haitian dress. Haitians
dress up for church services and if you choose to attend church on Sunday, you will not want to
feel underdressed. Please bring at least one nice outfit to wear to church service or special
occasion. We do not need to be super-formal, but men should wear collared shirts and slacks,
and may wish to wear a tie on Sunday. Most Haitian women wear a nice dress for church.
Socks and tennis shoes are best for the rugged, unpredictable terrain. It is very dusty – or very
muddy – depending on the season. Bring shoes that are good enough to prevent blisters and
give you good support, but old enough to get very dirty and perhaps left or thrown away. Many
bring sandals to wear, but remember that the terrain is rugged and walking will likely be easier
in tennis shoes or hiking shoes.
Bring flip-flops to wear in the shower. For visiting the beach, please bring modest swimwear.
When it comes to jewelry, the most conservative thing is to leave it at home. In addition to
putting you at greater risk, it may be offensive to the people with whom you will be working in
comparison to standard of living. At least only wear the most basic jewelry, such as simple
wristwatches, simple wedding bands and small earrings. Haitian males do not wear earrings, so
you may want to consider doing likewise.
Bring along bandanas to keep the dust out of your hair, nose and mouths while traveling. They
also come in handy for wetting to cool off your face and neck and wipe away sweat.
Laundry
Hired ladies will cook and take care of the house during your trip. They are willing to handwash your laundry for you. But unlike in America, where we wash our clothes often after one
wearing, make sure your clothing is dirty before asking them to wash it. Depending on the
weather, your laundry may take a couple of days to be returned to you. Also, laundry is more
rustic in Haiti so do not ask the ladies to wash precious garments that could be easily damaged.
You may wish to bring along detergent in a Ziploc bag.
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Packing for Your Trip
Try to pack lightly because you will have to carry your own luggage and you may not exceed 50
lbs total for all luggage. These are strict regulations. If the flight is not at weight capacity, MFI
may allow you to pay $1.50 per pound for your excess baggage. If the flight is at capacity, you
will have to leave the excess behind. To avoid this predicament, please weigh your luggage in
advance.
Bring older, durable luggage that can withstand dust and dirt. If possible, stick to one suitcase
and one small carry-on.
Packing List

Documents – passport and driver’s license (also bring a photocopy, packed separately. And leave
a photocopy back home with a trusted family member or friend), important phone numbers
 Clothing (as outlined earlier)
 T-shirts, pants, dresses and skirts, clothing for church, shorts, pajamas, underwear and socks,
swimsuit
 Shoes – gym shoes, shower shoes, dress shoes for church, rugged everyday shoes
 Personal care items (soap, shampoo, deodorant, powder, toothbrush, toothpaste, feminie hygiene
products, etc.)
 Prescription and over-the-counter medications, in original containers (Immodium etc.)
 Toilet paper (one or two rolls) and facial tissues
 Disinfecting wet wipes (for keeping you and the bathroom clean)
 Plastic grocery bags for toilet paper waste
 Towel and washcloth, pillow (if needed), sheets and pillowcase
 Bandanas (great for wetting to cool off and during work)
 Hat, ponytail holders, headbands, sunglasses and sunscreen
 Mosquito repellant and insecticide (clip-on works well to clip near you when sleeping)
 Mosquito netting for your bed
 Camera (it is possible to charge your camera at the ministry house while the generator is running)
 Wireless device for email (you will be able to get on internet in evenings when generator is on;
however your phone most likely will not work unless you have international service – check with
your cell provide before leaving U.S.)
 Flashlight and extra batteries
 Reading material (novel, Bible
 Journal and pen
 Water bottle or two (can be brought empty)
 Waterless hand sanitizer
 Waterless shampoo (Tresemme Dry Shampoo)
 A small battery-operated fan and replacement batteries.
 Snacks in a tight sealing plastic container (as suggested earlier)
 Small purse, tote bag, backpack for carrying items back and forth from housing compound and
school (perhaps your carryon bag)
Your luggage may be inspected by customs officials upon arrival as part of airport procedure.
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Teaching Beyond Borders
Study Abroad Application - Haiti 2014
Directions: Please complete the following pages by typing information in each field. Then print
and sign your completed application and submit to Dr. May by January 17, 2014.
Applicant Information
Last name
First name
Middle initial
Street Address
City
Date
Student ID
State
Zip
Date of Birth
Weight (needed for
Passport Number
Nationality
flight) Program of Study
Current GPA
Number of Credit Hours
Completed
Please list any honors, awards, and achievements
Have you ever traveled
YES
NO
abroad?
Have you ever been convicted YES
NO
of a felony or pleaded no
contest?
Do you have a current
YES
NO
passport?
How did you hear about this Study Abroad Program?
If so, when and where?
If yes, explain.
Expiration date?
How do you plan to fund your participation?
Emergency Contacts
Name
Relationship
Phone
Name
Relationship
Phone
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Most Recent Employment and/or Internship Information
Please list three professional or academic references
Company / School
Supervisor / Directing Teacher
From
To
Company / School
From
Volunteer Activities
Organization
Phone
Supervisor / Directing Teacher
To
Phone
From
To
From
To
Activity
Organization
Activity
Personal Statement
In the space provided below, please describe why you are interested in participating in this
study abroad program and what you hope to gain from this experience (500 words or less).
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
I am aware that payment deadlines exist and failure to meet these deadlines will result in being
dropped from the program. I also understand that payments made toward this program may
not be refundable.
Signature
Date
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TEACHER RECOMMENDATION
Teaching Beyond Borders - Haiti 2014
Directions: Students, please complete the top portion of this form. Select this one page and
either email or print for your professor / teacher.
To be completed by applicant
Last name
First name
Student ID
Date
Program of Study
Current GPA
Number of Credit Hours
Completed
Teacher Recommendation
Please use the space provided to explain what qualities the above student possesses that would
benefit the Teaching Beyond Borders Haiti project and any other pertinent information that
may help us in selecting participants:
Last name
Campus / School
First name
Date
Office Phone
Please email this letter to mayd@daytonastate.edu from your DSC email address or print, sign,
and mail to: Dr. Donald May, Daytona State College, College of Education, Bldg 200 Nunamann
Hall, Rm 308, 1200 W International Spdwy Blvd, Daytona Beach, FL 32114
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Daytona State College Release Form
Teaching Beyond Borders - Haiti 2014
VOLUNTARY ASSUMPTION OF RISK AND RELEASE OF LIABILITY
FOR INTERNATIONAL TRAVEL TO HAITI 2014
CAUTION: THIS IS A RELEASE OF LEGAL RIGHTS, READ AND UNDERSTAND IT BEFORE SIGNING.
Daytona State College is a non-profit educational institution. References to Daytona State
College (henceforth College or DSC) include the District Board of Daytona State College its
officers, officials, employees, volunteers, students, agents, and assigns.
I (print your name)___________________________________________, freely choose to
participate in the Teaching Beyond Borders – Haiti Study Abroad Program – Summer 2014
(henceforth referred to as the Program).
In consideration of my voluntary participation in the Program, I agree as follows:
SPECIFIC HAZARDS OF TRAVEL: Specific dangers endemic in the Program’s area of travel may
include but are not limited to the following:
Health Risks – participating students must understand the current health risks involved when
traveling to Haiti and must be cleared by a physician. Visit http://wwwnc.cdc.gov/travel for the
current health risks provided by the Centers for Disease Control and Prevention.
Travel Advisory - The Department of State urges U.S. citizens to exercise caution when visiting
Haiti. Participating students must be aware of these conditions (by visiting:
http://travel.state.gov/travel/cis_pa_tw/tw/tw_6051.html ) and agree to adhere to traveling
protocol outlined in the SAP information packet provided.
RISKS FOR TRAVEL/STUDY/WORK ABROAD: I understand that my participation in the Program
specified above involves risk not found in activities at the College or within DSC. These risks
include traveling to and within and returning from one or more foreign countries; foreign
political, legal, social, transportation, health and economic conditions; different standards of
design, safety, and maintenance of buildings, public places, and conveyances; local medical
facilities and providers; and local weather conditions.
INSTITUTIONAL ARRANGEMENTS: I understand that the College is not an agent of, and has no
responsibility for providing any services including food, lodging, travel, or other goods or
services, associated with the Program.
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INDEPENDENT ACTIVITY: I understand that the College is not responsible for any loss or
damage I may suffer when I am traveling with the Program. In addition, I understand that
participation in this Program is entirely at my own expense and risk.
HEALTH AND SAFETY: I have been advised to consult with a medical doctor with regard to my
personal medical needs. I state that there are no health-related reasons or problems that
preclude or restrict my participation in this Program. I have obtained the required
immunizations, if any.
I understand that I may be required to pay up front for my medical expenses that I incur while
traveling and in the host country. Further, I understand that my insurance policy may not cover
any medical expenses incurred during international travel that it is my responsibility to
purchase appropriate medical insurance. I recognize that the College is not obligated to attend
to any of my medical or medication needs, and I assume all risk and responsibility therefore. In
case of a medical emergency occurring during my participation in this Program, I authorize in
advance the representative of the Program to secure whatever treatment is necessary and is
warranted under the circumstances regarding my health and safety. I agree to pay all expenses
relating thereto and release the College from any liability for any actions.
STANDARDS OF CONDUCT: I understand that each foreign country has its own laws and
standards of acceptable conduct, including dress, manners, morals, politics, drug use and
behavior. I recognize that behavior, which violates those laws or standard, could harm my own
health and safety. I will become informed of and will abide by all such laws and standards for
each country to or through which I will travel during the Program.
I will attend to and assume responsibility for any legal issues or problems I encounter with any
foreign nationals or government of the host country.
TRAVEL CHANGES: If I become separated from the Program group, fail to meet a departure
airplane, bus, or train, or become sick or injured, I will, to a reasonable extent, and at my own
expense seek out, contact, and reach the Program group at its next available destination.
ASSUMPTION OF RISK AND REALEASE OF LIABILITY: Knowing the risks described above, and in
voluntary consideration of being permitted to participate in the Program, I agree to release,
indemnify, and defend the College and their officials, officers, employees, agents, volunteers,
sponsors, and students from and against any claim which I, the participant, my parents or legal
guardian or any other person may have for any losses, damages or injuries arising out of or in
connection with my participation in the Program.
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SIGNATURE: I indicate that by my signature below that I have read the terms and conditions of
participation and agree to abide by them. I have carefully read the Release Form and
acknowledge that I understand it. No representation, statement, or inducements, oral or
written, apart from the foregoing written statement, have been made. The Release Form shall
be governed by the laws of the State of Florida, United States of America, which shall be the
forum for any lawsuits to interpret this release. If any portion of this Release Form is held
invalid, the rest of the document shall continue in full force and effect.
Signature of Program Participant
Date
Signature of parent or Legal Guardian (if a student is a minor)
Date
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Vision of Hope Ministries Release Form
Teaching Beyond Borders - Haiti 2014
VOLUNTARY ASSUMPTION OF RISK AND RELEASE OF LIABILITY
FOR INTERNATIONAL TRAVEL TO HAITI 2014
CAUTION: THIS IS A RELEASE OF LEGAL RIGHTS, READ AND UNDERSTAND IT BEFORE SIGNING.
For adults eighteen years of age and older
In consideration of being accepted by Vision of Hope Ministries, Inc. for participation in a shortterm Study Abroad trip in Haiti, I hereby acknowledge that I do this as a service-learning project
in cooperation with Vision of Hope Ministries, Inc. and that I am receiving no wages for this
service, from Thursday, May 29, 2014 to June 5, 2014.
I understand all reasonable safety precautions will be taken at all times by Vision of Hope
Ministries, Inc. and its employees and agents while hosting my participation. I understand that
Vision of Hope Ministries, Inc. is a non-profit missions organization and as such does not carry
liability insurance for any loss due to damage, which may occur outside the United States. I
understand the possibility of unforeseen hazards and know the inherent possibility of risk. I do
hereby release, forever discharge and agree to hold harmless Vision of Hope Ministries, Inc., its
directors and its employees thereof from any and all liability, claims or demands for personal
injury, sickness or death, as well as any property damage and expenses, of any nature
whatsoever which may be incurred by the undersigned and the participant that occur while said
person is participating in work or recreational activities in Haiti with Vision of Hope Ministries,
Inc.
The undersigned further agrees to hold harmless and indemnify said Vision of Hope Ministries,
Inc., its directors, employees and agents for any liability sustained by said acts of said
participant, including any expenses incurred attendant thereto.
I understand that if I engage in activities, which adversely affect the Christian testimony and
moral standards of Vision of Hope Ministries, Inc. I will be subject to immediate dismissal from
participation with them and will be responsible to make alternate lodging and transportation
arrangements, at my own expense.
I consent to the use of any video images, photographs, audio recordings or any other visual or
audio reproduction that may be taken of the subject of this release while in Haiti to be used,
distributed or shown as Vision of Hope Ministries, Inc. sees fit.
I am aware of the recommendations of Vision of Hope Ministries, Inc. regarding seeking a
physician’s approval of good health appropriate for travel to Haiti, Tetanus shots/boosters,
Hepatitis A vaccinations, Hepatitis B vaccinations and preventative medications for Typhoid and
Malaria. The undersigned acknowledges personal responsibility to choose whether to follow
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these recommendations and agrees to hold harmless and indemnify Vision of Hope Ministries,
Inc. in the event of the development of any disease or any other health problems incurred by
the subject of this release while in Haiti.
Signature ________________________________________ Date ___________________
The undersigned consents to the admission of medical intervention, including but not limited to
first-aid, hospitalization, injections, anesthesia, surgery or any other form of medical treatment
necessitated by illness or injury that may require the same. In the event of the necessity of
such care or treatment as heretofore described, the undersigned agrees to hold harmless and
indemnify said Vision of Hope Ministries, Inc., its directors, employees and agents from any acts
of malfeasance, and/or failure to act on the part of those chosen to administer medical care on
behalf of the participant.
Signature _________________________________________ Date ___________________
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