Student Financial Assistance
COURSE PRE-APPROVAL AND CONSORTIUM
AGREEMENT FOR SEMESTER STUDY ABROAD
Section 1: Student Information
Name:
____________________________
Major:
__________________________________
Phone:
____________________________
Primary Campus:
__________________________________
VID:
____________________________
Program Name:
__________________________________
Atlas Email:
____________________________
Host Institution:
__________________________________
Term:
Fall
Winter/Spring
Summer
Year: ________________
Section 2: READ COMPLETION INSTRUCTIONS
1.
List all the courses in the table below that you plan to take during your study abroad program that you would like to
transfer back to Valencia (home institution).
2.
Submit the following with this form: host institution information (name, location, accreditation); course descriptions with
learning outcomes; and host institution cost sheet detailing all the program costs for the semester.
3.
There must be a Valencia course offered in the discipline that is equivalent to the course described in the materials in order
to receive transfer credit. These courses must also satisfy Valencia degree requirements if you will be using financial aid.
4.
Take this form along and the accompanying information to each program dean for sign off. Sign off may require more
than one dean’s signature since they specialize in different program areas.
5.
Students will be responsible to submit documentation from host school for their last date of attendance if they did not
complete the course and/or program. Only official documentation from the host school will be accepted. The host school
agrees to determine a student’s last date of attendance if the student did not complete the course and/or program.
6.
Submit this form and the accompanying information to the Study Abroad and Global Experiences (SAGE) office. The
SAGE office will: (1) obtain a signature from the HOST institution’s financial aid office confirming enrollment and
certification that no financial aid will be paid from their office; (2) forward your documents to the Financial Aid office for
processing; and (3) submit a copy of this form to the Admissions office.
Section 3: Valencia College Course Pre-Approval Form
STUDENT: List the courses for which you intend to enroll at the host institution (columns 1, 2, 3).
DEAN: List the courses that are equivalent (columns 4-7) and sign for the courses that you are approving to be fully credited
toward the student’s degree or certificate.
#1
#2
#3
#4
#5
#6
#7
Host Institution
Course Number
Host Institution Course Title
Start/End
Dates
Valencia Course
Number
Valencia Course Title
Gen Ed Reqmt
Credit
Hours
Dean Name:
Dean Signature:
Work Ext.
Dean Name:
Dean Signature:
Work Ext.
Dean Name:
Dean Signature:
Work Ext.
Dean Name:
Dean Signature:
Work Ext.
Dean Name:
Dean Signature:
Work Ext.
Dean Name:
Dean Signature:
Work Ext.
Student Financial Assistance
1800 S. Kirkman Rd., MC: 4-17 • Orlando, Florida 32811 • Phone: (407) -582-5570 • Fax: (407) 582-1173
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Section 4: Terms of Agreement by Valencia and the Host Institution
1.
Student is responsible for making payment arrangements at host school including study abroad programs.
2.
Student will be funded through Valencia, and all financial aid records for the period will be maintained in the financial
aid office.
3.
Student will be responsible for enrollment at the HOST institution and will be required to provide final grades at the
close of the semester, specified by this agreement to receive financial aid for future semesters. Have the official
transcript sent to the SAGE office. The transcript will be recorded and sent to the Admissions office.
4.
Student will be required to provide Valencia with confirmation of above enrollment at the HOST institution. Send a
copy to the SAGE office.
5.
These courses will be subject to Valencia’s Financial Aid Standards of Satisfactory Academic Progress.
6.
This agreement is valid only for those courses listed below. Any changes may require a new agreement be processed.
7.
Student may be required to be registered at Valencia prior to submitting this form except for Study Abroad Programs.
Valencia may require a minimum enrollment level.
Student Signature
Date
Host Institution Financial Aid Officer Signature
Date
Printed Name and Title
Telephone
Valencia Student Financial Assistance Signature
Date
Created: 6/15/11
Student Financial Assistance
1800 S. Kirkman Rd., MC: 4-17 • Orlando, Florida 32811 • Phone: (407) -582-5570 • Fax: (407) 582-1173
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