If you are a foreign national holding a foreign passport you may be required to provide additional documentation to travel to the country you have chosen for your program.

Although T&E offers informational support, it will be the sole responsibility of the participant to determine what documents are needed and to obtain those documents prior to departure.

                   Travel & Education: GROUP LEADER APPLICATION FORM


 PART A – PERSONAL DATA


*Full last name(s):
*Full First and middle name(s):
Gender:     Home Telephone #:     Cell Phone:

Home Address:
Number: Street: City:
State: ZIP:
*EMAIL ADDRESS: *(see important note below)

*NOTE: This email address will be used for invoicing and all important notifications.
Please provide an email (clearly and legibly) above which is current and regularly checked by the appropriate contact for this participant.



Age:     Date of Birth:         Citizen of
US Passport Other                            Passport No.  Issued by  
Date of Issue:  Date of Expiration:


Emergency contact while abroad:   Cell Phone:
Full Address:  City:
State:   ZIP code:
E-mail Address:  Relationship:

Cellhire Phone Number:


 PART B – INSTITUTIONAL AND PROGRAM INFORMATION


Institution of affiliation:  
Department:  
Title/Position:  
T&E Program Location:
T&E Program Dates:   to :  
Your Proficiency in Spanish:
Please indicate your role:
Pre-departure Orientation:
Requested date:  
Pre-departure Orientation Materials:
Address to send packets:  *
*Only for option:'I will conduct an orientation meeting at a future date therefore please send orientation packets for distribution to my group'

Program Billing:
Contact Name:  
Address Number: Street: City:
State: ZIP:
Specify if required:

Classroom Space Requirements.
Unless you have requested otherwise, as part of our general offer, T&E provides classroom space for meetings 2 days a week for a total of 1 hour maximum each day.
Please specify the days and times you are requesting classroom space:
Day 1:
Start time:  End time:

Day 2:
Start time:  End time:



 PART C – HEALTH AND HOUSING INFORMATION


Benefits for group leaders include the choice between private accommodations in an apartment (no meals included), private room in residence hall (private bath, meals included, internet access, shared for secondary group leader), private room with a family assigned to group leaders only (no students, all meals included).

PRIMARY GROUP LEADER CHOICES:
SECONDARY GROUP LEADER CHOICES:


Please answer the following questions to help us with finding an appropriate housing assignment:
DO YOU HAVE ANY ALLERGIES (TO HOUSEHOLD PETS OR OTHER) OR CHRONIC AILMENTS? If yes, please describe:

DO YOU HAVE ANY SPECIAL DIETARY NEEDS? If yes, please describe:

ARE YOU PRESENTLY UNDER TREATMENT FOR ANY MENTAL OR EMOTIONAL MATTERS? If yes, please describe:

ARE YOU PRESENTLY TAKING ANY PRESCRIPTION MEDICATION ON A REGULAR BASIS? If yes, please list and state purpose:

Studying Abroad requires a great deal of physical mobility. DO YOU FEEL YOU ARE ABLE TO PERFORM THE ESSENTIAL FUNCTIONS OF STUDYING ABROAD WITHOUT ANY SPECIAL REQUIREMENTS? If no, please describe:


Do you have any physical limitations that would require special attention or services? Please disclose any physical aliments or conditions you may have that require special medication or that have the potential to manifest side effects while you are abroad. If yes, please describe and provide a letter from a medical professional outlining the details of your condition (see note below)



OTHER DETAILS: Do you smoke?
Do you object to a roommate who smokes?
Would members of the host family who smoke elsewhere in the house or apartment bother you?
Would you prefer to live in a household with CHILDREN or without?
Would you object to being placed with a single person host?
If there are any other details about yourself which you think would help with the homestay selection and assist your host family in getting to know you better please state here:


 PART D – PAYMENT OPTIONS

If you are requesting any special items which require payment please choose one of the options for payment as specified below and make payment in the appropriate amount given your chosen options.



T&E cannot accept ATM/debit/Check cards above your daily limit. If you are charging your fees to a credit card, please supply the following information:
Credit Card Type:
Credit Card Number:   Expiration Date:
Amount to be charged:   3 Digit CDC on back of card:
Cardholder’s Address:

Phone:
Name of Card (if different from yours):
IMPORTANT NOTE: All payments made by credit card will be assessed a 3% handling fee for which participant will be billed separately.

 PART E – PRIMARY GROUP LEADERS ONLY

In order to help with the pre-departure communications and the on-site logistics of our program on the day of arrival and help with keeping you up to date on the events associated with your group we will need to have access to a working foreign number where you can be reached while you are abroad. To help in this effort T&E will be providing a foreign cell phone prior to your departure which will have a foreign number.


Please indicate your intentions for your group with regards to communications:
ON-SITE COMMUNICATIONS VIA MOBILE PHONE:

US Cell Phone:

ON-SITE COMMUNICATIONS VIA EMAIL*:

*Please note that internet access provided through T&E for group leaders will terminate upon completion of your program or upon your departure from the program site (whichever comes first) and you will be held responsible for the return of any equipment provided during your stay.

Pre-Departure Communications:

Contact Name:   Tel:   E-mail:
Specify Other:

 PART F – TRAVEL ITINERARY

In order for T&E to arrange the proper logistics for your group we will be requesting flight itineraries from all the individuals who make up the group. Please provide information that pertains to your group below:

TRAVEL PLANS FOR GROUP:

MY TRAVEL PLANS:
*PLEASE PROVIDE AIRLINE CONFIRMATION OF YOUR SPECIFIC FLIGHTS

 PART G – SPECIAL REQUESTS

T&E makes every effort to predict all of the necessities of our dedicated gruop leaders however at times there may be some special requests either based on past experience with our program or due to personal necessity. Please indicate, in detail, any special requests you may have regarding your program or your stay with us. Any special arrangements made with T&E via email should be referenced here if not already made clear above. Please attach any relevant emails or communications for confirmation.



Thank you for your input. T&E will make every effort to satisfy your necessities. Depending on your specific request there may a supplemental charge to consider. We will be in touch shortly with confirmation or more information.

 PART H – AGREEMENT AND RELEASE FORM


Click the button to read the

I acknowledge that I have read, understood and agree to all of the information, rules and guidelines set forth in this application. I also certify that the details I provided in the Required Disciplinary Information section are true.

A copy of the terms & conditions will be emailed to you upon completion of the application.


Required Disciplinary Information:

1. Have you ever been found responsible for a disciplinary violation at an educational institution you have attended at the college or university level, whether related to misconduct or behavioral misconduct which resulted in probation, suspension, removal, dismissal or expulsion from the institution?


2. Have you ever been convicted of a misdemeanor, felony or other crime?
If you answered “yes” to either or both questions, please email us and gives the approximate date of each incident and explains the circumstances.