SEAS STUDY ABROAD CLEARANCE FORM
Please complete and submit this form to Dr. Régine Lambrech (510 Mudd) to obtain approval for study
abroad. Then bring this signed form to the Office of Global Programs in 204 Lewisohn to finalize your
study abroad plans.
GENERAL INFORMATION
Please print legibly
Name: _____________________________________________ UNI _______________
Campus phone: ________________________________
Major/Concentration/Minor ________________________________________________
Number of credits completed ________________________
Cumulative GPA ________________
(to be eligible for participation in study abroad, students must have at least a 3.0 GPA)
** Transfer students are not eligible for academic semester or full year study abroad if they have
transferred more than 45 credits to Columbia from their previous higher education institution.
COURSE OF STUDY
Location_______________________________ Host University _____________________
Semester(s) planning to study abroad: Fall
Spring
Full Academic Year
CORE REQUIREMENTS Please check the appropriate core requirements. Indicate IP if in progress
Univ. Writing
_____
Gateway Lab
_____
Lit Hum, CC or Maj. Cult.
_____
Art Hum or Music Hum
_____
Economics 1105
_____
Professional Course
_____
Calculus
_____
_____
Physics
_____
_____
Chemistry
_____
_____
Computer Science (if required)
_____
Physical Education
_____
_____
_____
_____
_____
For core requirements not completed, please indicate the course and semester in which you plan to
complete them:
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? ____________________
How many major courses remain? ___________________________
Has your SEAS adviser approved your overseas course choices? ______________ If yes, please provide
the signed course equivalency form obtained from the Office of Global Initiatives. If no, please consult
with your departmental adviser before seeking clearance from the Office of Global Initiatives.
**Please note that while you are not required to take a language course the semester before studying
overseas, it is imperative that you have background in the language of the culture you will be studying in.
This can be demonstrated by 4 semesters of language courses or a recognized proficiency test in the host
language. If you have no language background in your host country’s language and you will be studying
in English, you are strongly advised (and most times required by the host institution) to take a Second
Language Class while you are overseas.
ACADEMIC AND DISCIPLINARY STANDING
Have you ever been on academic or disciplinary probation?
Academic Probation
Yes or NO
Disciplinary Probation
Yes or
NO
If yes to either of the above, please attach an additional sheet to explain the reasons for your probation and
your current standing.
SPECIAL NEEDS Please indicate if you have any special requirements
______ Non U.S. Citizen
_____ Disability
_____ Accommodation
______ Dietary Needs
_____ Religious Needs
_____ Medical Needs/On Medication
______ Financial Aid
If you have additional comments, please attach a separate sheet to this form.
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 towards fulfilling my
degree requirements.
Student Signature _________________________________________________
Date _____________
The information above has been verified and I indicate SEAS’ approval for this student to study
abroad.
Director of Global Initiatives Signature ___________________________________
Date ____________
The information above has been verified and I indicate approval for this student to study abroad.
Approval from the Office of Global Programs
OGP Signature ___________________________________________________
4/29/2009
Date ____________