Oriental Pearl TV Tower, Shanghai
Nissan Factory Tour
Nanjing Road, Shanghai
Orfalea College of Business
in cooperation with
Cal Poly Continuing Education
Orfalea College
Establishing International Supply Chains (BUS 304)
Intersession Course
APPLICATION AND RELEASE FORM
Cal Poly Student Tour - China
1
Orfalea College of Business
&
Cal Poly Continuing Education
Orfalea College
Establishing International Supply Chains (BUS 304)
Intersession Course
Date of Field Trip to Shanghai: March 16/17, 2012 to March 24, 2012 (tentative)
Faculty Coordinator/Professor: Chris A. Carr, JD (Cal Poly, San Luis Obispo)
Faculty bio: http://www.cob.calpoly.edu/faculty/chris-carr/
Welcome and thank you for your interest in the Orfalea College’s Establishing International Supply
Chains course (BUS 304)!
Participating students will earn 4 quarter units of academic credit while traveling to the People’s
Republic of China as part of this course, for an eight day field trip in Shanghai (3 days travel; 5 full
days on-the-ground).
The following materials provide you with basic information, an overview of the application process, the
application itself, and the various legal forms required for participation in the course and trip if you are
accepted into the course. The following materials also highlight pertinent deadlines and payment
schedules in preparation and planning for the course and tour.
Note: A Course Syllabus, Information Booklet, and an Expectations & Frequently Asked Questions
Document (“FAQ Document”) were previously provided or made available to you. You are expected
to have read those three documents, in detail, prior to reading and processing the following materials.
2
Orfalea College of Business
&
Cal Poly Continuing Education
Orfalea College
Establishing International Supply Chains (BUS 304)
Intersession Course
Date of Field Trip to Shanghai: March 16/17, 2012 to March 24, 2012 (tentative)
Application Process – Overview
This is a business course available to Orfalea College students for application and enrollment. Students from
other colleges and programs will also be considered for application and enrollment on a discretionary basis.
Students wishing to participate must also submit the following completed items, along with their initial nonrefundable deposit and payment of $300.00 USD, to Cal Poly Continuing Education by 4:00 pm of Friday,
October 21, 2011. Page ___ contains the Payment Receipt Forms you can fill out and return to Continuing
Education with your initial deposit and final payment.





Signed Application and Registration Form – pg. ____
Signed Cancellation and Refund of Fees Policy – pg. __
Signed Agreement between Cal Poly, SLO and Student Participant – pg. ___
Signed Medical Information and Authorization Form – pg. ___
Signed Assumption of Risk and Release Agreement – pg. _____
If you are not accepted into the course your $300 will be returned to you (and only in that instance).
You should have your valid passport in hand no later than December 2, 2011 (you will obtain your China visa
later).
Students accepted to participate in this course and tour must then submit the remaining $1500.00 USD nonrefundable balance for the course and tour to Cal Poly Continuing Education no later than Friday, January
13, 2012.
Students accepted to participate in the course and tour will also be expected to monitor and keep up to date,
review and comply with the following:




Any updates provided to them re: the Course Syllabus, Information Booklet, and/or the Expectations &
FAQ Document (again, see and refer to those three documents previously made available to you).
Any travel advisories applicable to this tour from the U.S. State Department, World Health Organization,
and/or Center for Disease Control, posted on their respective web sites.
All requests for additional information they receive from Cal Poly Continuing Education and/or the
Orfalea College.
Any notice of any mandatory pre-departure meeting.
3
Participants may also be contacted by Cal Poly Continuing Education and/or the Orfalea College for additional
information and/or materials. Students should anticipate, among other things, contact regarding making sure
they have obtained their passport and the required Chinese tourist visa.
It is important that students regularly check and closely read the email they have designated as their Cal
Poly email account as course information will often be sent to them via that email address. If you have
set it up so that an email sent to your Cal Poly.edu address is then forwarded to another email account,
please check and make sure your filter on that forwarding email account permit your Cal Poly email and
information to come through. I.e., check and adjust your filter settings!
Registration and Payment Delivery (location and mailing address)
Cal Poly Continuing Education
Jespersen Hall (Building 116), Room 101
California Polytechnic State University
San Luis Obispo, CA 93407-0442
Continuing Education Telephone Number: (805) 756 2053
*** You can mail in the completed and signed materials required by this Application and Release (with
your $300 non-refundable deposit) or hand-deliver them to Cal Poly Continuing Education
(recommended), but either way they must be RECEIVED by Cal Poly Continuing Education no later than
4:00 pm of Friday, October 21, 2011.
Passport and Chinese Tourist Visa
A passport AND Chinese tourist visa are required for travel to China. It will be your responsibility to obtain both
documents in a timely manner. See the Information Booklet for these details and how/when to obtain these
needed trip documents in a timely manner.
4
Application and Registration Form
Orfalea College
Establishing International Supply Chains (BUS 304)
Intersession Course
Date of Field Trip to Shanghai: March 16/17, 2012 to March 24, 2012 (tentative)
Note that this particular document is an application and registration form, and you are applying for a spot in this
course and on this trip. It is not a guarantee of acceptance or a spot on the trip. You are not accepted into this
course and trip until all of the requisite forms have been submitted, reviewed and approved by Cal Poly
Continuing Education and the Orfalea College. You will be notified by the Professor for the course (or his
designee) of your acceptance (or not) into the course and trip, no later than Monday, November 14, 2011.
_____________________
Empl. ID /Student ID
________________
Birth Date
_________
Age
______________
Gender: M/F
Name _________________________________________________________________
Last Name
First Name
Middle
Current (Local) Address __________________________________________________
Street Number
Street Name
Apartment
__________________________________________________
City
State
Zip Code
Cell Phone _________________________ Message Phone ___________________
Home phone ________________________
Cal Poly Email Address (we will use this to email you information) _________________________
Other email address you use (Gmail, Hotmail, other) ____________________________________ (if
your Cal Poly.edu email forwards to this email, please check your filter to make sure your emails from
Cal Poly are received and come through)
5
To enhance efficiency, can we release your phone number and/or e-mail address to other students
enrolled in the course and tour? Yes ____ No ____
What is your country of citizenship? __________________________________________________
Emergency Contact Information
Name of Person ________________________________________________________________
Last Name
First Name
Middle
Their Relationship to You ______________________________________________________
Their Address ________________________________________________________________
Street Number
Street Name
Apartment
______________________________________________________________
City
State
Zip Code
Their Home Number _________________________ Their Work Number _______________
Their Cell Phone ____________________________ Their E-mail _____________________
Your Major or Concentration
If you have declared your major or concentration, what is it? ________________________________
If you have not declared one, what is your intended major or concentration? ____________________
_________________________________________________________________________________
Your GPA
What is your Cal Poly GPA? _________________
What is your GPA in your major? ________________
6
Your Background and Interest in this Course
What is your interest in the supply chain area (briefly)?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
What is your interest in China (briefly)?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Please briefly explain any international experience or background you have.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Why do you want to participate in this course (briefly)?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Coursework
Have you taken an economics course at Cal Poly, other, or in junior college? Yes ____ No ____
If yes, what was the course(s) and what grade did you receive in the course? _________________
_______________________________________________________________________________
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Winter Quarter On-Campus Meetings
The syllabus notes that the on-campus portion and meetings of this course will take place Winter
quarter, and one day a week, on Fridays from 1:00 PM to 4:00 PM (this is tentative). For a class like
this we will either meet on that day and time, or, in the evening during another day of the week (or on
Friday morning). Do you understand this and are you willing to work with this game plan?
____ Yes
____ No
What is your preference for when those once a week, three hour, class meetings take place during
the Winter quarter? (List your top three choices – 1, 2, 3, with 1 being your first choice. Your
Professor will do his best to accommodate the majority of people and their preferences, find a room
we can meet in, etc. Note that not everybody may get his or her first choice. As the host of Project
Runway notes, “Work with me people.”)
____ Friday afternoon (1 pm to 4 pm)
____ Friday morning (9 am to 12 pm)
____ Monday evening (6 pm to 9 pm)
____ Tuesday evening (6 pm to 9 pm)
____ Wednesday evening (6 pm to 9 pm)
____ Thursday evening (6 pm to 9 pm)
____ Other -- list the day and time you would like: _____________________________________
Anything else you want us to know/your additional comments re: when you would like this class to
meet during Winter quarter, and why? _______________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Special Dietary Needs, Allergies and/or Medical Conditions:
If you have special dietary needs for/on the field trip to China please identify them:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Allergies, Pre-Existing Medical Conditions, Other That May Impact You On This Trip and/or When
Travelling Abroad (attach separate sheet if necessary):
_________________________________________________________________________________
_________________________________________________________________________________
________________________________________________________________________________
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Passport and Visa Information
1.
Do you have a passport? ?
Yes ____ No ____
2.
If you answered “yes” to question No. 1 above, what is your passport number, is it a US
passport (or other and if other what nationality), and when does your passport expire?
Note that if you do not have a passport or your passport will be expired before September 30, 2012,
you will need to apply for a passport or a new passport as soon as possible. To apply for a passport
for the first time, you need to go in person to one of over 9,000 passport acceptance facilities located
throughout the United States. Many post offices, including the post office in San Luis Obispo located
on Madonna Road, accept passport applications. You will need the passport application (which you
can find on-line) with two photographs of yourself, proof of U.S. citizenship (birth certificate,
naturalization certificate, etc.), and a valid form of photo identification such as a driver’s license.
Additional information on the passport application process can be found at the following link:
http://travel.state.gov/passport/passport_1738.html
3.
If you do NOT have a US passport, are you a US citizen?
Yes ____ No ____
If you answered “yes” to question No. 3 above, then you can ignore question Nos. 4-9 below. But if
you answered “no to question No. 3 above you must continue on and answer and complete the below.
4.
Are you a US permanent resident (do you have a "green card')? ?
Yes ____ No ____
If you answered “Yes” to question No. 4 above, please answer question Nos. 5-6 below. If you
answered “no” to question No. 4 above, please answer question Nos. 7-9 below.
5.
When was your permanent resident card issued and when does it expire (month, day and
year)?
_________________________________________________________________________________
_________________________________________________________________________________
6.
What is your US permanent resident (Alien) number? ________________________________
7.
What is your US visa type? __________________________________________________
8.
What is your US visa number? ________________________________________________
9.
What is your US visa issuance and expiration date? _________________________________
________________________________________________________________________________
________________________________________________________________________________
9
Payment Receipt Forms
(submit with your initial nonrefundable payment
and final nonrefundable payment)
Establishing International Supply Chains (BUS 304)
Intersession Course
Date of Field Trip to Shanghai: March 16/17, 2012 to March 24, 2012 (tentative)
-------------------------------------------------------------------------------------------------------------------------------------Receipt/Payment No. 1:
$300.00 USD Non-Refundable Deposit Payment due to Continuing Education by 4:00 PM of
Friday, October 21, 2011
Shanghai 2012
Payment Method: Check # _________________________ Amount __________________________
VISA/MC/AMEX/DISC: Account # _________________ Expiration Date: _______________________
Signature _________________________________________________Date____________________
_________________________________________________________________________________
---------------------------------------------------------------------------------------------------------------------------------------
Receipt/Payment No. 2:
Remaining Non-Refundable Balance and Payment due to Continuing Education by 4:00 PM of
Friday, January 13, 2012:
Shanghai 2012
Payment Method: Check # _________________________ Amount _________________________
VISA/MC/AMEX/DISC: Account # _________________ Expiration Date: _____________________
Signature _________________________________________________Date__________________
------------------------------------------------------------------------------------------------------------------------------------
10
Orfalea College of Business
&
Cal Poly Continuing Education
Orfalea College
Establishing International Supply Chains (BUS 304)
Intersession Course
Date of Field Trip to Shanghai: March 16/17, 2012 to March 24, 2012 (tentative)
Cancellation and Refund of Fees Policy
I have read and acknowledge acceptance of the terms of the cancellation and refund policy as
follows:
“I understand that should I cancel or withdraw from the course and tour after being accepted to
participate, regardless of the reason, I will receive no refund of the $300.00 USD non-refundable
payment I must make to Cal Poly Continuing Education on or before Friday, October 21, 2011. I also
understand that should I cancel or withdraw from the course and tour (regardless of the reason), I will
receive no refund of any fees paid including; the initial $300.00 deposit, the cost of my airplane ticket,
the remaining balance for the course and tour that is due in January 2012, and my passport or
Chinese visa fees. I also understand that if I am denied travel related documents from either the U.S.
or Chinese government due to my failure to supply requested information in a timely manner and/or
my own untimely application for said documents I will receive no refund of payment(s) made.
I also understand that if my application to participate in this course and trip is not accepted, I will
receive a refund of the initial $300.00 deposit.”
________________________________________
Student Signature
_______________
Date
11
Orfalea College of Business
&
Cal Poly Continuing Education
Orfalea College
Establishing International Supply Chains (BUS 304)
Intersession Course
Date of Field Trip to Shanghai: March 16/17, 2012 to March 24, 2012 (tentative)
Agreement between California Polytechnic State University, San Luis Obispo
and Student Participant
This agreement is entered into on behalf of the Trustees of the California State University and California
Polytechnic State University, San Luis Obispo, collectively referred to as “University” and
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , hereinafter referred to as “Student”.
[Print Student Name Here]
University and Student agree as follows:
VOLUNTARY PARTICIPATION
Student acknowledges that the Orfalea College’s Establishing International Supply Chains course (BUS 304) is
an elective course and therefore participation is optional and voluntary.
PROFESSIONALISM, PERFORMANCE, CONDUCT AND SANCTIONS
Student understands and agrees to attend and participate in all classes, excursions and/or meetings and/or
activities that are a part of the course and tour. Further, student has read Addendum A attached hereto, which
is hereby incorporated into this agreement by this reference, and also agrees to properly conduct himself or
herself in conformance with said Addendum at all times during the course and tour. Any violation of these
standards and expectations of professionalism, performance and/or conduct during the course and trip may lead
to sanctions being imposed, including, but not limited to, one or more of the following:


A reduced grade for the course, including the award of a “B”, “C”, “D” or “F”, and with no refund of monies
paid.
Suspension or expulsion from the course and tour, and with no refund of monies paid; and/or
12

Being taken to a nearby airport and being sent home early from the field trip, and with no refund of monies
paid.
Student acknowledges and agrees that the Professor has the discretion to make this decision and will be the
final and exclusive authority re: the determination of any violation of the standards of professionalism,
performance and conduct noted in Addendum A. In said case, student acknowledges that said Professor will
issue a verbal warning to the student no more than two (2) times. Student agrees that if the student’s
misconduct continues for a second time, then one or more of the above sanctions may be imposed. Student
further agrees that if the conduct at issue is egregious enough as determined by said Professor, the Professor
can immediately elect to impose one of more of the sanctions noted above.
Being Sent Home: Student further acknowledges and agrees that should the Professor make the decision to
send said student home early during the field trip, the student will be transported to a nearby airport (to be
determined by the Professor), have the student purchase a one way ticket back to the US with their own credit
card or funds, and send said student back to the departing airport in the US. Student acknowledges and
understands that the price of this ticket will be substantial (e.g., potentially in the thousands of dollars). Student
further acknowledges and agrees that if he/she refuses to pay for said air/hotel/room and/or food charges, the
Professor can elect to do so and will then turn collection of that amount over to Cal Poly upon his return to the
US, which may include: (1) the filing of a legal collection action against the student; (2) attaching the student’s
wages from their employer; and/or (3) withholding the granting of their degree, registration and/or other
university services.
Further, in addition to the above noted sanctions, student further acknowledges and agrees that said
misconduct and/or unprofessionalism can also result in the following disciplinary measures being taken against
him or her:


Expulsion from their undergraduate program; and/or
Not being awarded their undergraduate or other degree
Student also understands and agrees that their student records and/or student disciplinary records may be
accessed and reviewed by the Professor (or his/her agents) for the course and tour.
UNIVERSITY SERVICES
The University shall provide appropriate academic supervision for the course and tour offered and shall grant
academic credit for the successful satisfactory completion of said course and tour and all required deliverables.
The University reserves the right to cancel and/or modify the course and tour at its discretion where student
interest, availability of adequate faculty or resources, or other relevant criteria indicate such cancellation or
modification to be appropriate.
ACADEMIC PROGRAM
Student agrees that he or she will expend his or her best efforts in successfully completing all of the academic
requirements for the course and tour in a timely manner.
COURSE FEE AND TOUR SUPPORT
Course Fee -- $1,800.00 USD. Said fee assumes a currency exchange rate of 6.5 RMB to 1 USD, and it
includes:



Tuition for the four unit course, and, the University, College, and Continuing Education overhead incurred in
the planning, offering and execution of this course and trip
Scheduled hotel accommodation in Shanghai (including breakfasts, taxes and Internet in your room; note
that if you require your own room you can expect to pay an additional/single room surcharge in the range of
$400 USD)
Hotel conference or other meeting rooms we will use/rent for our meetings and activities
13




Scheduled transportation in Shanghai (i.e., bus airport pick up and drop off for the group flight (only), and
the bus to and from our various firm visits)
Scheduled lunches in Shanghai
Speaker and firm gifts and honorariums
Emergency Travel Insurance (this is required by the University and we will obtain this for you after you enroll
in the course)
Note: Should the above noted currency exchange rate shift the amount of this course fee may be adjusted.
ITEMS AND SERVICES NOT COVERED BY THE COURSE FEE
Required textbooks for the course -- $30 USD estimate for this item.
This amount includes:


The Starr book (Understanding China). If you buy from Amazon.com, with shipping, this will cost you less
than $20 USD.
The Bowman textbook. This will cost you less than $10 – we will later advise re: how you can best
purchase and access this book.
Travel from SFO or LAX to Shanghai and Back -- $700 USD estimate if you book a one stop ticket and a
$950 USD estimate if you book a non-stop ticket
This amount includes:

Round trip airfare to Shanghai out of LAX or SFO. Your ticket price could be less and we (or you) may get a
better deal on a flight and ticket, but it could also be more. Thus, for planning purposes, the best number
we can give you at this time for this year’s trip is $700 USD for a one stop ticket to and from Shanghai and
$950 USD for a nonstop ticket to and from Shanghai. If a one stop ticket, the “stop” is either often an
international airport in Vancouver, Japan, Korea, Taiwan, or Hong Kong.
Passport and China Visa --$195 to $330 USD
This amount includes:


Passport, if you don’t already have one (estimate of $135 – $110 for the application fee and $25 for the
acceptance fee = $135; see the Passport discussion later in this Information Booklet)
One year multiple entry tourist (L) visa to enter China (estimate of $145 for the visa and $50 for the
outsourcing firm fee to process = $195; see visa discussion later in this Information Booklet)
Miscellaneous:
Here is a list of “off-the-clock” type expenses that we see students sometimes incur on international field trips
like this. Of course, the amounts will vary by the student and the good judgment they use or do not use.
A travel guide book of China or Shanghai you may choose to buy on your own
 Any overage charges on any bags you check with the airlines due to weight limitations
 Domestic transportation from SLO to LAX or SFO – see below for budget ideas and options in this regard.
Note that as many students are from southern or northern California and they would be going home for
Spring break anyway, this is an expense many students would still be incur over spring break
 Entertainment, sightseeing and shopping in Shanghai while you are off-the-clock (can vary widely by
student)
 Taxis and/or other mode of transport while you are off-the-clock (will vary widely by student; but taxis are
cheap in China!)
14




Food and drink for lunch and dinner while you are off-the-clock (we estimate this at less than $80 USD for
our entire stay in Shanghai if you make good choices and don’t eat at every Outback Steakhouse or
California Pizza Kitchen you see in Shanghai)
Possible cost of your own business cards, if you elect to get these and you don’t already have these (will
vary by student; these can be done cheaply)
Any room charges you incur (e.g., soda’s, snacks and food, movies, laundry, telephone, room damage, etc.)
(will vary by student)
Any doctor’s office visit in Shanghai that you might incur for something unexpected that for some strange
reason is not covered by your Emergency Travel Insurance policy we will purchase for you
Further, the University is not furnishing and is not responsible for and assumes no liability in connection with
matters other than academic instruction and logistical services detailed above. The University is not furnishing
and is not responsible for and assumes no liability of guarantee or assurance of the health and/or safety of
participants and/or the elimination of all risks from the environment. The University is not furnishing and is not
responsible for and assumes no liability for the safety of personal property during participation in the program.
The University is not furnishing and is not responsible for and assumes no liability for monitoring and/or control
of all the daily personal decisions, choices, and activities of the individual participants. The University is not
furnishing and is not responsible for and assumes no liability for the prevention of participants from engaging in
illegal dangerous or unwise activities, including but not limited to situations that my arise due to the failure of a
participant to disclose pertinent information. The University is not furnishing and is not responsible for and
assumes no liability for assumption of responsibility for the actions of persons not employed or otherwise
engaged by the University, for events that are not part of the program, or that are beyond the control the
University and its subcontractors. The University is not furnishing and is not responsible for and assumes no
liability for assurance that home-country culture values and norms will apply in the host country. The University
is not furnishing and is not responsible for and assumes no liability for the safety of any student who is
dismissed from the trip and is sent home early.
STUDENT RESPONSIBILITIES
Student shall complete, execute (sign), and deliver to Cal Poly Continuing Education by 4:00 pm of Friday,
October 21, 2011:
o
o
o
o
o
Application and Registration form – pg. ___
Cancellation and Refund of Fees Policy – pg. ____
Agreement Between Cal Poly, SLO and Student Participant – pg. ____
Medical Information and Authorization form – pg. ___
Assumption of Risk and Release Agreement – pg. ___
Student shall obtain, on their own, all necessary passports, visas and health certifications (if deemed necessary
by the U.S., and/or Chinese government) for participation in the course and tour. Proof of international health
insurance that meets or exceeds the benefits provided by the CSU Study Abroad Program is required, and said
insurance which satisfies this requirement is included in the fee for this course and tour. Student will receive the
necessary insurance from Cal Poly Continuing Education upon acceptance into the course and tour, and if/when
requested must timely return said completed and signed insurance form(s) back to Cal Poly Continuing
Education and/or the insurance carrier. Student further acknowledges and agrees that any logistical
arrangements entered into by him/her to enable his/her participation in the course and tour (e.g., transit to and
from the Los Angeles or San Francisco airports to fly to Shanghai; or they elect to travel to and from Shanghai
on their own and arrange their own ticket and not be a part of the group flight that will be arranged, etc.) are the
sole responsibility of the student and that the University is not responsible for the services, payments or
guarantees provided pursuant to such arrangements and is not responsible for any injury arising out of such
logistical arrangements and transport.
ACADEMIC CREDIT
Student shall be enrolled in the Orfalea College course (BUS 304 – Establishing International Supply Chains)
through Cal Poly Continuing Education in four (4.0) academic units. Student understands and agrees that this
15
course and tour can only be taken for a letter grade and not on a “Credit/No Credit” or “Audit” basis. Student
also understands and agrees that the plus/minus grading system will be used in this course.
16
POLICY ON REFUNDS AND CANCELLATION
Cancellation and refunds will be governed by the Cancellation and Refund of Fees Policy which is a part of the
application materials and is hereby incorporated into this agreement by this reference. That policy describes the
cancellation and refund policy applicable to this course and tour. That policy states that the initial $300.00 USD
deposit as well as the remaining balance due for the course and tour are NON-REFUNDABLE. Students who
are denied travel related documents, from either the U.S or Chinese government, due to reasons that are not
related to their own failure to supply requested information in a timely manner and/or own untimely application,
will receive a refund of fees paid. Further, if a the student is not accepted into the course, their $300 USD
deposit will be returned (and only in that instance).
COURSE SYLLABUS, INFORMATION BOOKLET, AND EXPECTATIONS & FREQUENTLY
ASKED QUESTIONS DOCUMENT HAVE BEEN PROVIDED OR MADE AVAILABLE TO
STUDENT
Student acknowledges and agrees that a copy of an extensive Course Syllabus, Information Booklet, and a
Expectations & Frequently Asked Question (“FAQ Document”) were provided to him/her and/or made available
to him/her, that he/she has read each document, that he/she understands them, and that he/she has asked the
Professor any follow-up questions he/she may have had arising from his/her review of those documents.
ASSUMPTION OF RISK AND RELEASE
Assumption of Risk and Release matters and issues not addressed above will be governed by the Assumption
of Risk and Release Form, which is a part of the application materials and is hereby incorporated into this
agreement by this reference.
MEDICAL INFORMATION AND AUTHORIZATION
Medical Information and Authorization matters and issues, including the Authorization for Consent to Medical
Treatment document, which is a part of the application materials is hereby incorporated into this agreement by
this reference.
LAWS, REGULATIONS AND REFUNDS
This Agreement is subject to all applicable laws and regulations unless otherwise provided herein. If
performance of this Agreement involves violation of applicable law or regulation thereby making it legally
impossible to perform and such illegality is not the fault of Student, the University shall refund to the Student all
appropriate fees paid pursuant to this agreement as authorized in section 41802 of title 5 of the California
Administrative Code; upon payment of said refund all rights of University and Student are expressly waived
under this agreement. No refunds will be made for fees already paid in the event of the dismissal and expulsion
of the participant from the course and tour or if the participant leaves the course and tour (for whatever reason).
SOLE AGREEMENT
This Agreement and the various supplemental documents incorporated herein by reference, contain the sole
and entire agreement between the University and Student and shall supersede any and all other agreements
between the parties. The University and Student further acknowledge and agree that any statements or
representations that may have, heretofore, been made by either of them has not been relied thereon in
connection with his or her or its dealings with the other.
SEVERABILITY
If any one or more of the terms or provisions of this agreement shall to any extent be declared invalid,
unenforceable, void or voidable for any reason by a court of competent jurisdiction, none of the remaining terms
17
or provisions of this agreement shall be affected thereby, and each provision of this agreement shall be valid
and enforceable to the fullest extent permitted by law.
DEFEND, INDEMNIFY AND HOLD HARMLESS
Student shall defend, indemnify, hold harmless and protect the State of California, the Trustees of the California
State University, California Polytechnic State University, San Luis Obispo, their officers, employees,
representatives, agents, students and volunteers (the “University”) from and against any and all liability, loss,
damage, expense, cost (including without limitation the costs and attorney fees of litigation) of every nature
arising out of or in connection with Student’s participation in this course and tour hereunder or failure to comply
with any obligations of the Student contained in the agreement, except such loss or damage which is caused by
the sole negligence or willful misconduct of the University.
CHOICE OF LAW AND JURISDICTION
The laws of the State of California shall exclusively govern this agreement. The State of California, County of
San Luis Obispo, shall also be the sole and exclusive forum for any lawsuits filed under or incident to this
agreement or to the course and tour.
In anticipation of acceptance and as consideration for participating in this course and tour, I agree to the terms
of the Agreement between California Polytechnic State University, San Luis Obispo and Student Participant, the
additional forms incorporated herein (Addendum A, Cancellation and Refund of Fees Policy, Assumption of Risk
and Release Form) and that I have read them and understand them. I also acknowledge that I have reviewed
and understand the Medical Information and Authorization Form which accompanies the application materials,
including the Authorization for Consent to Medical Treatment, and I also agree to its incorporation into this
agreement by this reference. The terms under which I agree to participate in the course and tour cannot be
changed or amended except in writing and signed by an authorized office of the University.
This Agreement is approved and accepted:
_____________________________________________________
Student Signature
__________________
Date
_____________________________________________________
Brian Tietje, PhD
Dean, Cal Poly Continuing Education
__________________
Date
_____________________________________________________
Matthew Roberts
Contracts and Procurement, Cal Poly State University
___________________
Date
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Addendum A
Students are expected to be good citizens and to engage in responsible behaviors that reflect well upon their
university, to be civil to one another and to others in the campus community, and to contribute positively to
student and university life.
Section 41301, Title V, California Code of Regulations, notes that the following behavior is subject to sanctions
(including dismissal from the course and trip, program, being sequestered away from other students during the
trip, no awarding of a degree from Cal Poly, and/or a grade reduction in the course to a B, C, D or F):
(1) Dishonesty, including:
(A) Cheating, plagiarism, or other forms of academic dishonesty that are intended to gain unfair
academic advantage.
(B) Furnishing false information to a University official, faculty member, or campus office.
(C) Forgery, alteration, or misuse of a University document, key, or identification instrument.
(D) Misrepresenting oneself to be an authorized agent of the University or one of its auxiliaries.
(2) Unauthorized entry into, presence in, use of, or misuse of University property.
(3) Willful, material and substantial disruption or obstruction of a University-related activity, or any on-campus
activity.
(4) Participating in an activity that substantially and materially disrupts the normal operations of the University, or
infringes on the rights of members of the University community.
(5) Willful, material and substantial obstruction of the free flow of pedestrian or other traffic, on or leading to
campus property or an off-campus University related activity.
(6) Disorderly, lewd, indecent, or obscene behavior at a University related activity, or directed toward a member
of the University community.
(7) Conduct that threatens or endangers the health or safety of any person within or related to the University
community, including physical abuse, threats, intimidation, harassment, or sexual misconduct.
(8) Hazing, or conspiracy to haze, as defined in Education Code Sections 32050 and 32051.
(9) Use, possession, manufacture, or distribution of illegal drugs or drug-related paraphernalia, (except as
expressly permitted by law and University regulations) or the misuse of legal pharmaceutical drugs.
(10) Use, possession, manufacture, or distribution of alcoholic beverages (except as expressly permitted by law
and University regulations), or public intoxication while on campus or at a University related activity.
(11) Theft of property or services from the University community, or misappropriation of University resources.
(12) Unauthorized destruction, or damage to University property or other property in the University community.
(13) Possession or misuse of firearms or guns, replicas, ammunition, explosives, fireworks, knives, other
weapons, or dangerous chemicals (without the prior authorization of the campus president) on campus or at a
University related activity.
(14) Unauthorized recording, dissemination, or publication of academic presentations (including handwritten
notes) for a commercial purpose.
(15) Misuse of computer facilities or resources, including:
(A) Unauthorized entry into a file, for any purpose.
(B) Unauthorized transfer of a file.
(C) Use of another’s identification or password.
(D) Use of computing facilities, campus network, or other resources to interfere with the work of another
member of the University Community.
(E) Use of computing facilities and resources to send obscene or intimidating and abusive messages.
(F) Use of computing facilities and resources to interfere with normal University operations.
(G) Use of computing facilities and resources in violation of copyright laws.
(H) Violation of a campus computer use policy.
(16) Violation of any published University policy, rule, regulation or presidential order.
(17) Failure to comply with directions of, or interference with, any University official or any public safety officer
while acting in the performance of his/her duties.
(18) Any act chargeable as a violation of a federal, state, or local law that poses a substantial threat to the safety
or well-being of members of the University community, to property within the University community or poses a
significant threat of disruption or interference with University operations.
(19) Violations of the Student Conduct Procedures, including:
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(A) Falsification, distortion, or misrepresentation of information related to a student discipline matter.
(B) Disruption or interference with the orderly progress of a student discipline proceeding.
(C) Initiation of a student discipline proceeding in bad faith.
(D) Attempting to discourage another from participating in the student discipline matter.
(E) Attempting to influence the impartiality of any participant in a student discipline matter.
(F) Verbal or physical harassment or intimidation of any participant in a student discipline matter.
(G) Failure to comply with the sanction(s) imposed under a student discipline proceeding.
(20) Encouraging, permitting, or assisting another to do any act that could subject him or her to discipline.
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Orfalea College of Business
&
Cal Poly Continuing Education
Orfalea College
Establishing International Supply Chains (BUS 304)
Intersession Course
Date of Field Trip to Shanghai: March 16/17, 2012 to March 24, 2012 (tentative)
Medical Information and Authorization Form
_________________________________________
Student Name
________________________
Empl. ID/Student ID
__________________________
Birth date
__________________
Gender M/F
_________________________
Home Phone
___________________________
Cell Phone
_________
Age
___________________
Work Phone
_______________________________
Emergency Contact Name & Number
___________________________
Email
____________________________
Doctor’s Name
____________________
Doctor’s Phone
___________________________
Insurance Company
______________________
Policy Number
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Authorization for Consent to Medical Treatment
The participant named above states that the participant is in good health and knows of no conditions
contrary to active participation in this course and tour. The participant authorizes the Professor (or
his/her agent, other Cal Poly faculty or staff member who accompanies the Professor on the tour (or
the Professor’s accompanying spouse) to consent to any diagnostic procedure (including x-rays), to
the administration of any medical or surgical treatment, or to any hospital care when any, or all are
rendered under the general supervision of any licensed physician and/or surgeon.
The participant agrees that the University is not responsible for any medical, dental or other expenses
resulting from the exercise of this authorization. This authorization is given in advance of any specific
diagnosis, treatment or medical care being required, and pursuant to the intent and provisions of
Section 6910 of the California Family Code.
____________________________________
Student’s Signature
_________________
Date
22
Orfalea College of Business
&
Cal Poly Continuing Education
Orfalea College
Establishing International Supply Chains (BUS 304)
Intersession Course
Date of Field Trip to Shanghai: March 16/17, 2012 to March 24, 2012 (tentative)
ASSUMPTION OF RISK AND RELEASE AGREEMENT
THIS IS A RELEASE OF LEGAL RIGHTS – CLOSELY READ AND
UNDERSTAND BEFORE INITIALLY AND SIGNING
Name of Participant: (print legibly)_________________________________________
I hereby agree as follows:
Risks of Off Campus Study
I understand that participation in this course and tour involves risk not found in study at the University. These
may include risks involved in traveling to and within, and returning from, one or more foreign countries; foreign
political, legal, social, economic and health conditions; different standards of design, safety and maintenance of
buildings, public places and conveyances and transportation; local sanitation, health, medical and weather
conditions.
I understand that travel advisories often change and I agree to perform my own periodic personal review of
current travel advisories issued by the U.S. Department of State, the Center for Disease Control and the World
Health Organization, and I am willing to accept these risks.
Initial _________
Risks of Air, Taxi, Bus, Subway, Boat, Shuttle and Train Travel
Participation in this program may requires air, taxi, bus, shuttle, subway, train and/or boat travel. Each of these
forms of travel involves risks and could result in damage to property, injury to persons and death. The
University assumes no liability for damage, injury, and death, which may occur during these modes of travel
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required by participation in this course and tour. Participation in this course and tour is voluntary and I
acknowledge that my participation is at my own risk.
Risks include: bodily injury, death, illness, property loss and/or damage, acts of terrorism, kidnap,
extortion, and incarceration.
Initial _________
Risk of Personal Property Damage or Loss
I understand that the travel in this course and tour presents a risk of theft or damage to my personal property
and I agree that the University is not furnishing and is not responsible for and assumes no liability for damage to
or theft of any of my personal belonging or property during my participation in this course and tour, including but
not limited to, my laptop, cell phone, camera, computer equipment, any currency I bring with me, luggage,
passport and visa.
Initial__________
Health and Safety
A. I have consulted with a medical doctor with regard to my personal medical needs for this course and tour,
with respect to China. I am aware of all applicable personal medical needs. There are no health-related reasons
or problems that preclude or restrict my participation in the course and tour. Should that situation change
between now (when I fill out and submit this document) and when we leave, I will promptly notify the Professor
for the course in writing.
B. I agree to meet any and all of my needs for payment of medical costs while I participate in the course and
tour. I recognize that the University is not obligated to provide any of my medical or medication needs. If I
require medical treatment or hospital care, in a foreign country or in the United States during the course and
tour, the University is not responsible for the cost or quality of such treatment or care.
C. The University may, but is not obligated to, take any actions it considers to be warranted under the
circumstances regarding my health and safety. I agree to pay all expenses relating thereto and release the
University from any liability for any actions.
I assume all risk and responsibility for my medical needs.
Initial _________
Americans With Disabilities Act (ADA)
I understand that China is not bound by the ADA or obligated to comply with this piece of US legislation. If I
have a disability, I agree to promptly disclose it to the Professor and I also agree that the Professor (or his/her
agent) has the unilateral and non-appealable discretion to decide whether I can (or cannot) participate in this
course and trip.
Initial _________
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Private Information
In acknowledge that my academic program, the Orfalea College and/or the University, may, as a part of
executing this course and trip, release certain information to the travel agency, hotel, the embassy or consulate,
and some of the companies or other entities we will visit. Such released information may include, but is not
limited to, my date of birth, driver’s license number and expiration date, passport or visa number and expiration
dates, my telephone number or email, my gender, and in the case of the travel agency or airline my credit card
information. I understand that this information may be used to register me in my hotel, buy or issue my airline
ticket, obtain my passport or visa, or register me with an embassy or consulate for safety precautions, obtain
approval for a firm, company or government agency visit, etc.
Initial _________
Photographs and Videos
I hereby irrevocably consent to and authorize the use by my academic program, the Orfalea College, the
University, and/or the firms, businesses, entities or government agencies that were visited or will be visited in
connection with this course and trip, of any and all photographs, audio tapes and audio-visual tape recordings
taken of me including derivative works thereof, and any reproduction of them in any form in any media
whatsoever, throughout the world. I also consent to the use of my own name or any fictitious name which may
be chosen in connection with the aforesaid photographs. I hereby release any and all claims whatsoever in
connection with the use of my photographs, audio tapes and audio-visual tape recordings and name and the
reproduction thereof as aforesaid. I also hereby waive any right that I may have to inspect and/or approve the
use of the aforesaid photographs, audio tapes, audio-visual tape recordings or any reproductions thereof, by
said entities.
Initial _________
Standards of Conduct
A. I understand that each foreign country has its own laws and standard of acceptable conduct, including dress,
manners, morals, politics, drug use and behavior. I recognize that behavior which violates those laws or
standards could harm the University’s relations with those countries and institutions therein, as well as 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 course and tour.
B. I also will comply with the University’s rules, standards, and instructions for student behavior and the
expected rules, standards and instructions for student behavior and conduct during the course and trip. I waive
and release all claims against the University that arise at a time when I am not under the direct supervision of
the University or that are caused by my failure to remain under such supervision or to comply with such rules,
standards, and instructions.
C. I acknowledge and understand that any violation of the above standards of conduct, rules and expectations,
could lead to sanctions and/or disciplinary measures being imposed on me that are consistent with CSU Student
Discipline Policies and Procedures, including, but not limited to:
Sanctions:


A reduced grade for the course, including the award of a “B”, “C”, “D” or “F”, and with no refund of monies
paid.
Suspension or expulsion from the course and tour, and with no refund of monies paid; and/or
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
Being taken to an appropriate airport and being sent home early from the trip, and with no refund of monies
paid.
Disciplinary Measures:


Expulsion from their undergraduate program; and/or
Not being awarded their undergraduate or other degree
D. I will attend to any legal problems I encounter with any foreign nationals, ex-patriots, or government. This
includes, but is not limited to, my incarceration. The University is not obligated or responsible for providing any
assistance under such circumstances.
Initial __________
Independent Activity and Travel
A. I understand that the University is not responsible for any injury or loss I may suffer when I am acting or
traveling independently or am otherwise separated or absent from any University-supervised activities. This
includes, but is not/limited to, free or “off the clock” time during the course and tour and/or travel to or from the
point of departure and return from China (e.g., Los Angeles, San Francisco, other). It also includes any decision
by me to elect to remain overseas or in Shanghai after participation in the tour, in which case I will cease to be a
part of the course and tour.
B. I accept all responsibility for loss or additional expenses due to delays or other changes in the means of
transportation, or other services, or sickness, weather, strikes, or other unforeseen causes.
C. If I become detached from the course and tour group, fail to meet a departure by bus, airplane, or train, or
become sick or injured, I will, at my own expense, seek out, contact, and reach the course and tour group at our
hotel or the group’s next available destination, and to enable me to do so I will always keep on my physical
person a copy of the trip schedule/itinerary.
I waive and release all claims against the University that arise at a time when I am not under the direct
supervision of the University or that are caused by my failure to remain under such supervision or to comply with
such rules, standards and instructions.
Initial _________
Institutional Arrangements
I understand that the University does not represent or act as an agent for, and cannot control the acts or
omissions of, any host institution, host firm, company or family, government agency, transportation carrier, hotel,
tour organizer or other provider of goods or services involved in the course and tour. I understand that the
University is not responsible for matters that are beyond its control. I hereby release the University from any
injury, loss, damage, accident, delay or expense arising out of any such matters.
Initial _________
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Program Changes
The University has the right to make cancellations, substitutions or changes in case of emergency or changed
conditions or in the interest of the course and tour. I understand that the University’s fees and program charges
are based on current airfares, lodging rates, and travel costs which are subject to change. If I leave or am
expelled from the course or tour for any reason, there will be no refund of fees already paid.
Initial _________
ASSUMPTION OF RISK, RELEASE OF CLAIMS, INDEMNITY, CHOICE OF LAW AND
JURISDICTION
Knowing the risks described above, and in consideration of being permitted to participate in this elective course
and tour, I agree, on behalf of my family, heirs, and personal representative(s), to assume all the risks and
responsibilities surrounding my participation in this course and tour, including those which may occur during
transit to or from any country where the course and tour is being considered.
I shall also defend, indemnify, hold harmless and protect the State of California, the Trustees of the California
State University, California Polytechnic State University, San Luis Obispo, their officers, employees,
representatives, agents, students, and volunteers (the “University”) from and against any and all liability, loss
damage, expense, cost (including without limitation to costs and fees of litigation) of every nature arising out of
or in connection with my participation in this optional course and tour thereunder or my failure to comply with
any of my obligations contained in this Assumption of Risk and Release Agreement, except such loss or
damage which was caused by the sole negligence or willful misconduct of the University.
The laws of the State of California shall also exclusively govern this agreement. The State of California, County
of San Luis Obispo, shall also be the sole and exclusive forum for any lawsuits filed under or incident to this
agreement or to the course and tour.
Initial _________
I have carefully read this Assumption of Risk and Release Agreement before signing it. No
representations, statements, or inducements, oral or written, apart from the foregoing, have been made.
________________________________
Signature of Participant
___________________
Date
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