Semester in
Rome & Florence,
Italy
with Santa Barbara City College
Program dates: February 1 - April 30, 2016
Deadline for applications is October 23, 2015
Contact the Santa Barbara City College Study Abroad Office at 805.730.4294 or testoker@pipeline.sbcc.edu
or Prof. David Elliott at dmelliott@pipeline.sbcc.edu with any questions.
ACCENT International Consortium for Academic Programs Abroad
Rome & Florence, Italy
I
mmerse yourself in experiential learning and spend the spring semester 2016 in Rome and Florence
with Santa Barbara City College! The SBCC Semester Abroad in Rome and Florence includes courses
in world history, art history, and Italian language.
While in Italy you will experience Italian culture through study, instruction, and immersion in daily
Italian life. Your home base will be in Rome, the 2,700 year-old Italian capital whose streets are filled
with history and architectural masterpieces and museums and churches that hold priceless works
of art, and in Florence, the capital city of the Italian region of Tuscany, which is famous for its history
and which is considered the birthplace of the Renaissance. Visits to other notable cities in Italy are
included in the program.
The program is academic in nature, but it also provides you with the opportunity to make new friends,
become acquainted with Italy’s living history, and learn through direct experience with Italian language,
customs, and cuisine.
If you have questions about any aspect of this program, please feel free to contact the Santa Barbara
City College Study Abroad Office at 805.730.4294 or testoker@pipeline.sbcc.edu or contact ACCENT at
800.869.9291.
February 1 - April 30, 2016
Student Services: The ACCENT Centers
ACCENT is an independent study abroad program provider with a multinational team of staff members who all have personal experiences in study abroad.
With more than 20 years of experience coordinating high-quality overseas study programs, ACCENT works in partnership with U.S. colleges and universities
to develop academically challenging and culturally enriching overseas study experiences in Paris, Florence, London, Madrid, Rome and Istanbul. Each city is
home to a fully-staffed ACCENT Study Center that serves as a home base for program participants. The ACCENT San Francisco Center coordinates program
enrollment and pre-departure preparation for students, helping to make their transition to living overseas as smooth as possible.
The fully-staffed ACCENT Rome and Florence Study Centers provide on-site support services to program participants. The ACCENT Rome Study Center
is located in the historic city center near the Piazza Navona. The ACCENT Florence Study Center is centrally located near the main historic sights of the city
including the Ponte Vecchio. The ACCENT Study Centers are open during the week for students to use the resource and lending library, ask questions, check
their email in the computer lab and collect their mail. The ACCENT staff provide a wide variety of on-site student services and are an invaluable resource for
students who want to find out more about their host city.
Academic Curriculum
All of the courses that are offered as part of the program are usually transferable to the University of California and California State University. Check with your
counselor for possible exceptions. You must enroll in 14 units.
Course
Description
Units
History 103
Western Civilization from Beginnings until 1660
3
History 120
Modern Europe from 1900 until Present
3
Art History 210
Renaissance and Baroque Art
3
Italian 101 or 102
Italian Grammar
5
Program Requirements
Program Director
The Spring Semester in Rome & Florence Program is open to students who
are at least 18 years of age by the departure date to Rome. You do not have to
be currently enrolled at SBCC, but you must enroll at SBCC for the spring
2016 semester in order to participate in the Rome and Florence program. By
the time of application, you must have completed at least 12 college units
with a grade point average of at least 2.5. Furthermore, you should have
completed English 110. You do not have to be a history or art history major
and there is no language requirement.
Professor David Elliott received his M.A. in History from UCSB in 1995
and his B.A. in German Literature and in History in 1991. Professor Elliott's
graduate studies included doctoral work and concentrated on European fields
of history, including the Italian Renaissance. He has traveled throughout
many parts of Europe and has studied abroad as a student in both Ireland and
Germany. Professor Elliott relates his most memorable travel experiences were
those encountered in Communist Eastern Europe in 1985 and 1989. In 2006,
Professor Elliott directed SBCC's semester program in Florence, Italy.
Application Procedure
Program Housing
Deadline for application: October 23, 2015. Apply early as the number of
places is limited and as the program is likely to fill before the deadline. If the
program is full before the deadline, acceptance is not guaranteed. Applicants
may be accepted after the deadline if space is available. Application forms are
available at the SBCC Study Abroad Office and online at http://www.sbcc.
edu/studyabroad/website/applications.php. You are required to submit a first
payment of $250 with your application. An interview with a Study Abroad
representative will be scheduled upon receipt of your application. If you live
outside the Santa Barbara area, you may be interviewed by telephone.
Cultural Program
Cultural learning is an integral part of the Semester in Rome and Florence
program. Participants attend on-site lectures at museums and historical
sites within and outside both cities. Included in the program are: a one-day
excursion to Pompeii, or similar, including coach transport, full-day guide,
entries, and lunch; a one-day excursion to Siena, or similar, including coach
transport, half-day guided tour, and entries to the Duomo and Museo Civico
(includes headsets); two-day, one-night excursion to Venice, or similar, including train transport, half-day guided tour, and entries to the Palazzo Ducale.
Accommodations in a two-star hotel (double/triple/quad rooms) including
daily breakfast. Excursions chosen based on the academic curriculum and subject
to change.
Informational Meetings
Students live with other program participants in double or triple rooms in
shared student apartments in Rome and Florence and double/triple/quad
accommodations on overnight excursion. In most cases the Rome and Florence
apartments accommodate four to six students with two to three students per
bedroom and kitchen facilities are provided. Meals are not included in the
program other than breakfast daily in the excursion hotel in Venice. A $375
supplement will be charged for a single room in an apartment and availability
varies according to apartment. Single rooms are not guaranteed. Housing is
provided from the first day of the program (February 1, 2016).
Program Timetable
Application due: with first payment
Second payment due: October 23
Final payment due: November 23
Pre-departure orientation: Dec. (TBD)
Departure from U.S.: January 31
Arrival in Rome: February 1
Overseas Orientation: February 2
Classes Begin: February 3
Midterm break: March 12 - 20
Informational Meetings - SBCC Library Conference Room
June 2 4:30 - 5:30
Sept 1 5:30 - 6:30
July 8 4:30 - 5:30
Sept 2 2:30 - 3:30
Sept 15 5:30 - 6:30
Sept 16 2:30 - 3:30
Depart Rome/Arrive Florence: March 21
National holidays: March 28, April 25
Return to U.S.: April 30
For more information on the SBCC Spring Semester Program Contact:
ACCENT
870 Market Street, Suite 1026
San Francisco, CA 94102
Ph.: (800) 869-9291
FAX: (415) 835-3749
Santa Barbara City College
721 Cliff Drive
Santa Barbara, CA 93109
Ph.: (805) 965-0581
FAX: (805) 963-7222
Study Abroad Office
Santa Barbara City College
Office: IEC-1, Ext. 2494
Tara Stoker
testoker@pipeline.sbcc.edu
Office: IEC-2 - 805.730.4294
Program Director
Prof. David Elliott
dmelliott@pipeline.sbcc.edu
Office: IDC-361, Ext. 2480
For information about financial aid, scholarships, and travel information, please visit our website: www.sbcc.edu/studyabroad/website
Program Price: $6,995
plus a $200 refundable security deposit
(The price is based on 20 or more program participants. If less than
20 students enroll in the program, the program may be canceled.)
Program Price Includes
• Double or triple rooms in shared student
apartments, double/triple/quad rooms on over-
night excursions
• Two one-day excursions to Pompeii and Siena, including transportation, entries and guides
• A two-day/one-night excursion to Venice, including transportation, accommodations,
and half day guided tour
• Pre-departure and overseas orientation program and practical walking tour of areas around the ACCENT Rome and Florence Centers
• Welcome and farewell dinners
• Overseas information and resource center
with ACCENT Rome and Florence on-site staff
• Rome transit pass
• Transfers from housing to train station in Rome
and train station to housing in Florence
• Eurostar train transfer from Rome to Florence
• Transfers from the Rome and to the Florence
airportfor group flight participants
Program Price Does Not
Include
• Round-trip airfare (estimated airfare: $1300 - $1500)
• Transportation to and from LAX
• SBCC registration fees (see description)
• Optional supplement for single room in
program housing ($375)
• Meals except as described
Payment Schedule
(not including airfare)
Non-refundable first payment $250
Second payment due Oct 23
$3,495
Final payment due Nov. 23
$3,450
The above breakdowns include the $200 refundable security deposit. The payment schedule is the
applicant's contractual obligation. Failure to make
each payment when due shall automatically cancel
participant from the program one week after payment due date. All payments are effective the day
they are received by the ACCENT San Francisco
Center. ACCENT, in its sole discretion, may reinstate an applicant subject to availability of space
and late enrollment fees. ACCENT charges a $30
bounced check fee for each check received that is not
promptly paid by your bank in the normal course
of business.
Payments
After you are accepted to the program, your non-refundable first payment check will be forwarded
to ACCENT, travel contractor for the program.
Please send the second and final payments to
ACCENT directly by the due dates listed on the
following payment schedule. Send payments to:
ACCENT, 870 Market Street, Suite 1026, San
Francisco, CA 94102. Phone: 800.869.9291. If
you are accepted to the program after payment
dates have passed, you are required to make the past
due payment immediately.
Financial Aid
To apply for financial aid, you go to the Federal
Student Aid website: www.studentaid.ed.gov to
fill out the FAFSA (Free Application for Federal
Student Aid) or to the SBCC Financial Aid Office.
It may take a minimum of 4-6 weeks to process
your paperwork and determine your eligibility for
aid. ACCENT offers a Deferred Payment Plan for
students receiving financial aid awarded through
SBCC. For more information, please contact
ACCENT at 800.869.9291.
• Required medical insurance
Scholarships
• Travel insurance
If you are eligible for financial aid, you are encouraged to apply for the Benjamin A. Gilman scholarship, which provides awards of up to $5,000 to eligible applicants. Please visit the following website to
learn more about the Gilman Scholarship: www.iie.
org/gilman Apply early as the application deadline
is October 1, 2015. If you would like to apply for
an SBCC scholarship, please pick up a scholarship
application form in the SBCC Study Abroad Office.
The deadline for submission for spring programs is
November 1, 2015. Awards usually amount to $500
- $1000, and the number of awards varies according
to the number of qualified applicants.
• Personal expenses, books, passports, visas, and anything not listed as included
Transportation
All participants must check-in at the ACCENT Rome Center February 1, 2016 between 9am
and 5pm (Note: most transatlantic flights depart
one day before their arrival date). ACCENT
will organize an optional round-trip group flight
from Los Angeles. Airfare is not included in the
program fee. Group flight participants will be met
at the airport in Rome and transferred to their
housing. Group flight participants returning to the
U.S. on the group return date will receive transportation to the Florence airport. Participants on the
program will receive detailed optional group flight
information approximately four months prior to
departure. Estimated airfare $1300 - $1500.
Insurance
It is your responsibility to obtain your own medical insurance. ACCENT requires proof of such
insurance. Upon request, ACCENT will supply
information concerning health/travel/cancellation
insurance options.
Registration & SBCC Fees
In the fall we will send you registration materials so
that you can register for the program courses online.
SBCC fees are not included in the program cost.
California residents pay $46 per unit; non-California residents and international students pay $312
per unit. You are required to enroll in 12 units. Fees
are subject to change. Though personal spending
habits vary widely, we suggest taking at least $1500
per month for food and personal expenses.
Visas
A visa is written permission from the a Consulate
to visit or temporarily reside in a country and is
granted by the government of that country. The
duration of this program is less than 90 days and
therefore, at the time of this printing, U.S. citizens
do not require a visa to participate on this program.
U.S. citizens are permitted a one-time stay for up to
90 days (within a 6 month period) in the collective
countries of the Schengen Territory without a visa.
Therefore, if you extend your travel dates beyond
the dates of the program or beyond 90 days from
the start date of the program, whichever is greater,
you are subject to visa requirements. It is your
responsibility to assess visa requirements and, if necessary, acquire a visa before your departure.
Passports
Specific information about obtaining a passport
is available online at: http://travel.state.gov, by
calling (877) 487-2778, or in Santa Barbara from
the County Clerk-Recorder at 568-2250. Apply
for one immediately since passport numbers are
needed to make international air reservations 60
days prior to departure and to get an Italian visa.
It may take up to twelve weeks to obtain a passport. If you already have one, check its expiration
date to make sure it will not expire until at least
six months after your return.
Cancellations
If you have to withdraw from the program,
you must notify the Study Abroad Office. All
cancellations must also be made in writing to
ACCENT and are effective the date of receipt by
ACCENT. Participants are liable for payments
until written cancellation is received.
Cancellation Fees:
70 days or more prior to start of program $250
50 to 69 days prior to start of program
$2500
30 to 49 days prior to start of program
$3000
15 to 29 days prior to start of program
$3500
0 to 14 days prior to start of program No Refund
Although the Santa Barbara Community College District has attempted to determine
the accuracy of this brochure, the District does not assume any liability with respect
to the contents of the brochure. Courses offered, together with other related matters
contained herein, are subject to change without notice by the administration and/or
Governing Board of the Santa Barbara Community College District for reasons related
to enrollment, finances, scheduling, dates, costs or for any other reason, at the discretion
of the District. The District further reserves the right to add, amend or repeal any of its
rules, regulations, policies and procedures. Travel, housing, meals and other logistical
arrangements are provided by a contracting agency not affiliated with Santa Barbara
Community College District. Participants will be required to sign a travel request and
release which will exonerate the District from any liability. All courses are subject to
approval by the Governing Board of Santa Barbara Community College District. All
students must enroll for course credit (credit/no credit option available when indicated
in the catalog); no auditors are allowed. Units and course grades will be awarded by
Santa Barbara City College.
ACCENT is not responsible for the academic segment of the program except as specified
in the contract between ACCENT and Santa Barbara City College. Nor is ACCENT
responsible for airline delays of any kind, or for expenses or loss incurred as a result
of such delays. With regard to transportation/travel, regardless of the type of vehicle,
ACCENT acts for the passenger as agent only. ACCENT assumes no liability for
accident, injury, damage, or loss in any vehicle, or as a result of default by any person or
company engaged in transporting the passenger. CST #1013432-40.
Santa Barbara City College Study Abroad Program
Application Procedure - Italy Spring Semester 2016
February 1 - April 30, 2016
(January 31 departure from the US)
Deadline for Application: October 23, 2015. Apply early as the number of places in the program is limited and as the program may fill
before the deadline. If the program is full before the deadline, acceptance is not guaranteed. Applications may be accepted after the deadline,
if space is available. This application is for participation in the Italy Spring Semester 2016 Study Abroad Program only. To apply to the
program, please submit the following:
1 Application form. If you change addresses after submitting your application, please provide the Study Abroad Office with your new
address.
1 Unofficial Transcript.
1 Responses to questions (typed or printed clearly). Please answer the questions listed on the back of the application form.
1 Two 2 x 2 photos. Two recent photos that are a full-face view are acceptable. Please trim them to fit. Pictures from a passport service
1
1
1
1
1
or a photo booth are acceptable. Print your name with a ballpoint pen on the back of each picture and staple the pictures in the box
on the application form. Please do not submit copy machine copies of your passport photo.
Completed Student Conduct Release Form. The top of this form is to be completed by you and taken to the Office of Students at the
institution you currently attend. If you currently attend SBCC, please take the form to the Office of Student Support Services in the
Student Services building, Second Floor, Room SS-260. The bottom of the form will be completed by the appropriate student official
and returned to the SBCC Study Abroad Office. Your acceptance to the program is not final until the form is returned to the Study
Abroad Office. If you are not a current student at SBCC you need to submit the form to the Dean of your institution for approval.
Two completed recommendation forms, which are included in this application. At least one must be completed by an instructor, preferably an SBCC instructor, if you are an SBCC student. The second form may be completed by a person who knows you well such as
an employer, supervisor, or long-time family friend. Please no recommendations from relatives, roommates or boy or girl friends. the
recommendation forms do not have to be attached to or submitted with your program application.
SBCC Enrollment. If you will not be enrolled at SBCC for the spring 2016 semester, you must complete the SBCC Admissions
Application online at www.sbcc.edu/apply/ and enroll for the spring 2016 semester.
$250 non-refundable first payment. Payment may be made by check or money order made out to Accent. Please put your check or
money order in an envelope and staple it to your application.
Submit your application. Applications must be complete and include the application form, answers to the questions and photos.
Incomplete applications will not hold a space in the program.
By mail:
Santa Barbara City College
or give it to:
Study Abroad Office
721 Cliff Drive
Santa Barbara, CA 93109 Santa Barbara City College
Study Abroad Office
International Education Center, Office # 1
(On SBCC East Campus at the end of the upper parking lot)
Interview. After receipt of your application, you will be contacted to arrange an interview with Professor David Elliott. For applicants not
living in the Santa Barbara area, interviews can be completed by telephone.
Notification of Acceptance by SBCC. Carola Smith, SBCC Senior Director of International Programs, will notify you of your acceptance
by SBCC to the program after your interview and after a review of your application documents.
Communication. The SBCC Study Abroad Office and Accent will communicate with you by e-mail and regular mail. We will be using your
SBCC PIPELINE e-mail for primary communication. If you change your mailing address or e-mail, please notify the Study Abroad
Office immediately by sending your new information to testoker@pipeline.sbcc.edu.
Santa Barbara City College
721 Cliff Drive
Santa Barbara, CA 93109
Phone: (805) 965-0581
FAX: (805) 963-7222
Study Abroad Office
Office: #1
International Education Center
Phone: 805.730.4294
E-mail: testoker@pipeline.sbcc.edu
Program Director
Prof. David Elliott
dmelliott@pipeline.sbcc.edu
Office: IDC-361, Ext. 2480
ACCENT
870 Market Street, Suite 1026
San Francisco, CA 94102
800 869-9291
www.accentintl.com
Study Abroad Website: www.sbcc.edu/studyabroad/website
All statements made on this sheet and distributed generally to prospective or accepted participants shall be for informational purposes only
and should not be interpreted as being contractual for any purpose.
1I currently attend ____________ and am attaching an SBCC enrollment form to this application.
1I currently attend ____________ and enrolled at SBCC on-line on __________________ (date).
1 I currently attend SBCC.

1. Staple two 2" x 2" size photo here.
SANTA BARBARA CITY COLLEGE
APPLICATION FORM
2. Using a ball point pen, print your
name and SBCC-RomFloSP16 on
the back of the photos.
ITALY SPRING SEMESTER, 2016
Program dates: February 1 - April 30, 2016
Legal Name ___________________________________________________________ K No. ___ ___ ___ ___ ___ ___ ___ ___
Last
First
Middle (as it appears in your passport)
(Your K number is under the bar code on your SBCC student ID card)
Current Address ___________________________________________________________________________________________________
StreetApt. or Box No.CityStateZip
Phone (home or cell) (___ ___ ___) - ___ ___ ___ - ___ ___ ___ ___
Work phone (___ ___ ___) - ___ ___ ___ - ___ ___ ___ ___
Address after current semester ends _______________________________________________________________________________________
StreetApt. or Box No.CityStateZip
Phone after current semester ends (___ ___ ___) - ___ ___ ___ - ___ ___ ___ ___ Date of Birth ___ ___ - ___ ___ - ___ ___
Participants must be 18 years old on the day of departure.
SBCC Pipeline E-mail address ______________________________ @ __________________________ Please print your e-mail address very
clearly. (THIS WILL BE OUR PRIMARY FORM OF COMMUNICATION WITH YOU)
Secondary E-mail ______________________________________@_______________________________
Citizenship (country) ________________
Please indicate the best times to reach you at your current phone: _____________________________________________________________
If you are not currently attending Santa Barbara City College, what school are you attending? ________________________________________
Please list the names of two people who may be contacted in the event of an emergency. These people may be parents, guardians, relatives,
or close friends.
Name _____________________________________________
__________________________________________
Address ______________________________________________
__________________________________________
City, State, Zip _____________________________________
__________________________________________
Phone
______________________________________________________________________________________
Relationship
_________________________________________________________________________________
I hereby authorize SBCC representatives to contact and discuss with the persons listed above my status in the study abroad program.
I further authorize Carola Smith, Senior Director of International Programs, to review my student conduct file.
Signature ________________________________________________
Date _____________________________________________
1 I would like to apply for ACCENT’s Deferred Payment Plan. Please send me the Deferred Payment Plan eligibility packet. ACCENT’s Deferred
Payment Plan may allow me to defer payment of up to 40% of the ACCENT program fees by using Financial Aid awarded through my school. I
understand that if I am accepted into ACCENT’s Deferred Payment Plan, the plan will constitute an amendment to the terms and conditions in
this program brochure.
----->
Request for Special Accommodations. If you have a disability for which you will be seeking special accommodations abroad, please contact the
SBCC Disabled Students Programs and Services (DSPS) specialist immediately to begin discussions about reasonable accommodations. Phone: (805)
968-0581, ext. 2364. Office: Student Services Building. The process to reach agreement on reasonable accommodations must take place before you
leave the US. Students who disclose needs at the last minute or who require accommodations that cannot be made available in the host country, may
be advised to postpone participation or consider another program
Do you have a medical condition that may prevent you from being able to function in the following or situations or to participate in the following
activities?
1 Walking on uneven surfaces for at least two miles
1 Climbing several flights of stairs
1 Sitting in buses/trains/airplanes for extended periods of time
1 Being able to adjust to substantially different diets
1 Being able to function at times in extremely hot or adverse weather conditions
If you checked any of the activities listed above, please note your medical condition. The information will be shared with our Health and Wellness
Program. If you have questions regarding your health as it relates to your ability to participate in the study abroad program, please consult with your
physician. __________________________________________________________________________________________________________
_________________________________________________________________
I have carefully read the brochure for the SBCC Semester in Rome and Florence Program and wish to apply. I agree to the terms and conditions
stated in the program brochure, including the payment and refund policies. I understand that if there are any changes in the terms and conditions
ACCENT will notify me in writing. The applicant shall be the client of ACCENT for all purposes. Any applicable refunds will be returned to the
applicant regardless of the source of payment.
Signature _____________________________________________
Date __________________________________________
Required Legal Document Forms
If I do not complete and return the required Study Abroad legal document forms by the stated due date, I may be canceled from the program and
held responsible for any cancellation penalties, which may apply. Signature____________________________________________ Date _________________________________________
Responses to Questions. On a separate sheet of paper, please answer the following questions. You may either type or clearly print your responses.
Please limit all your answers to 1 - 2 pages.
1 What are 5 things that you are looking forward to about studying abroad?
1 What are 5 challenges that currently worry you the most about going overseas?
1 How do you think the values and perspectives of the host country will be different from your own cultural values?
1 How do you think you will be perceived by the people in the host country based on your nationality and cultural heritage?
Santa Barbara City College
Recommendation for Study Abroad Program #1
Please fill out the following recommendation form for _____________________________ who
(name of student)
is applying to study in Santa Barbara City College’s Italy Study Abroad Program.
Your honest appraisal of this student is appreciated.
***
A = excellent
B = good
C = average
D = poor
X = no opportunity to observe
A
B
C
D
X
Academic ability to do college level course work
Emotional stability to live abroad
Flexibility/openness to new and different experiences
Tolerance and openness to cultural differences
Sense of personal responsibility
Respect for authority and program guidelines
Sense of cooperation
Consideration of others/works well with groups
Other personal characteristics (friendliness, enthusiasm, humor,
etc.)
Overall evaluation
Comments (optional)
Thank you! Please return to:
Study Abroad Office
Santa Barbara City College
721 Cliff Drive
Santa Barbara, CA 93109
ame: __________________________________________________
N
Relationship to applicant: ___________________________________
Phone: __________________________________________________
Date: ___________________________________________________
Santa Barbara City College
Recommendation for Study Abroad Program #2
Please fill out the following recommendation form for _____________________________ who
(name of student)
is applying to study in Santa Barbara City College’s Italy Study Abroad Program.
Your honest appraisal of this student is appreciated.
***
A = excellent
B = good
C = average
D = poor
X = no opportunity to observe
A
B
C
D
X
Academic ability to do college level course work
Emotional stability to live abroad
Flexibility/openness to new and different experiences
Tolerance and openness to cultural differences
Sense of personal responsibility
Respect for authority and program guidelines
Sense of cooperation
Consideration of others/works well with groups
Other personal characteristics (friendliness, enthusiasm, humor,
etc.)
Overall evaluation
Comments (optional)
Thank you! Please return to:
Study Abroad Office
Santa Barbara City College
721 Cliff Drive
Santa Barbara, CA 93109
ame: __________________________________________________
N
Relationship to applicant: ___________________________________
Phone: __________________________________________________
Date: ___________________________________________________
Santa Barbara City College
DEAN OF STUDENTS CONDUCT RELEASE FORM
To the SBCC Study Abroad Applicant:
1. Please complete the top part of this form.
2. If you currently attend SBCC, submit this form to Dr. Ben Partee, Dean of Students, in the Student Services Building, Room # SS-260 (second
floor). If you currently attend another college or university, give this form and an envelope that has a stamp and is addressed to Santa Barbara
City College, Study Abroad, 721 Cliff Drive, Santa Barbara, CA 93109, to the Dean of Students at your school.
3. Ask the Dean to complete the bottom part of the form and return it to the SBCC Study Abroad Office.
Name ___________________________________________
Last
First
Middle
K No. ___ ___
___ ___
___ ___
Address _________________________________________
City, State, Zip________________________________________
Dates of Attendance at ________: From ______ to ______
Study Abroad Program location __________________________
(if you are an SBCC student)
___ ___
I hereby consent to the Dean of the college I am currently attending to furnish Santa Barbara City College with the information on the form below
and I hereby waive my right of access to any statements by said Dean evaluating me and my activities.
Signature _____________________________________________
Date __________________________________________
To the Dean:
The student named above has applied to participate in a study abroad program at Santa Barbara City College. We will be grateful for your comments that will be kept confidential.
1. Has this student been subject to any disciplinary actions? Yes ____ No ____ If yes, please explain.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
2. Are any disciplinary charges pending? Yes ____ No ____ If yes, please explain.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
3. Has this student been expelled, suspended, placed on probation, required to withdraw, or given a reprimand or warning?
Yes ____ No ____ If yes, please explain.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
4. Is this student eligible to re-enroll at your college? Yes ____ No ____ Conditionally ___ If yes or conditionally, please explain.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
5. Any additional comments you may wish to make regarding this student.
________________________________________
____________________________________________________________________________________________________
Thank you for taking time to complete
this form and returning it as soon as
possible to:
Study Abroad
Santa Barbara City College
721 Cliff Drive
Santa Barbara, CA 93109
Signature___________________________________________
Name (Please print) ___________________________________
Title ________________________________________________
Institution ____________________________________________
Phone _______________________________________________