COLUMBIA COLLEGE
STUDY ABROAD CLEARANCE FORM
Please complete and submit the following form to Dean Scott Carpenter (105 Carman) to obtain approval to study abroad.
Bring your signed form to the Office of Global Programs in 606 Kent for review and to finalize your plans.
GENERAL INFORMATION.
Name: _______________________________________________________ UNI: _________________________
Advisor: ________________________________
Major/Concentration: ______________________________________
Total number of credits completed: ____________
Are you a transfer student?
YES
NO
Cumulative GPA: ____________
(To be eligible for participation in an approved study abroad program, students must have at least a 3.0 GPA.)
Semester(s) planning to study abroad:
FALL ____
SPRING ____
FULL YEAR ____
CORE REQUIREMENTS Please check the appropriate core requirements. Indicate “IP” if in progress.
Univ. Writing
_____
Lit Hum
_____
CC
_____
Art Hum
_____
Music Hum
Science
_____
Foreign Language _____
Global Core
_____
Physical Education
Swim Test
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
For core requirements not completed, indicate the course and semester in which you plan to complete the requirement:
Course: _______________________________
Semester to be completed: _________________________
Course: _______________________________
Semester to be completed: _________________________
Course: _______________________________
Semester to be completed: _________________________
ACADEMIC MAJOR
How many courses have you completed for your major/concentration? ________________________
How many major/concentration courses remain? ________________________
Have you discussed your study abroad plans with your department?
YES
NO
APPROVED PROGRAM OF INTEREST Please verify that the program of interest is on the APPROVED program list at
http://www.ogp.columbia.edu. If the program is NOT on approved program list, please provide supporting documentation for consideration to the Office
of Global Programs (606 Kent).
Name of Program: _________________________________________________________________________________
Location: _________________________________________
LANGUAGE REQUIREMENT
I. Does your program of interest have a language requirement? YES
If YES, please indicate the program and number of terms required below:
Language: ___________________
NO
Number of Terms Required: _________
REGIONAL COURSE REQUIREMENT
You are required to take a course about the country or area in which you intend to study before you go. This course should address the contemporary
social, political, intellectual, or cultural issues of your study abroad host country.
Please indicate the regional studies course you have taken in the area where you plan to study. Indicate “IP” if in progress.
Course: ____________________________________
Term: _________________
Grade: _________
ACADEMIC AND DISCIPLINARY STANDING
Have you ever been on academic or disciplinary probation?
Academic probation: YES
Disciplinary probation: YES
NO
NO
If YES to either of the above, be prepared to discuss this with study abroad staff.
SPECIAL NEEDS Please indicate if you have any special needs.
____ Non-U.S. citizen
____ Financial Aid
____ Disability
____ Dietary Needs
____ Religious needs
____ Medical Needs / On Medication
MEDICAL ISSUES Studying abroad is an adventure for both the mind and the body. In order to ensure that students remain healthy and
productive while studying abroad, we ask that you disclose and discuss any ongoing medical issues you have. Understanding the accessibility of
treatment and support in your future host country and coordinating ongoing care between your providers here and overseas are vital steps to this end.
Disclosure on this form allows Columbia’s study abroad personnel to help you with this process. The information you provide will be kept confidential
and will be used only to aid in advising you.
Do you have any medical or psychological conditions? If so, please check this box so that we can discuss your needs for taking
care of yourself with study abroad staff:
YES
NO
ADDITIONAL COMMENTS Use additional sheets as necessary.
My signature below indicates that the information provided is correct and that I have taken the appropriate steps to
plan out the remaining core, major, and elective classes toward fulfilling my degree requirements.
Student Signature _________________________________________________ Date ______________
STUDY ABROAD DEAN: Please verify the information provided and sign below indicating Columbia’s approval to
study abroad for this student (See Dean Scott Carpenter, 105 Carman).
Dean Signature ___________________________________________________ Date ______________
OFFICE OF GLOBAL PROGRAMS: Please have an OGP Advisor approve your study abroad plan (606 Kent).
OGP Signature ___________________________________________________ Date ______________