France 2015 Summer Study Abroad Program Applications accepted beginning December 1, 2014. No applications accepted prior to this date. Applicant Information 1. First Name:_____________________ Middle Name:________________ Last Name:________________________ 2. Current Address: City:_____________________ ST: ____________ Zip: _______________ Country:_____________________ ☐ Check here if current address is same as permanent address and proceed to #4. 4. Email: _________________________________ 3. Permanent Address: Mobile phone: __________________________ City: _____________________ ST: ____________ Zip: ____________ Other phone: ___________________________ Country: _________________________________________ Note to University of Iowa Students: Your @uiowa.edu email is the official email address used by the University to communicate with you. All official communication will be sent to that address. To setup or configure your email account, visit My Ulowa at http://isis.uiowa.edu. If yes, Hawk ID:________________Student ID #______________ 5. Are you a University of Iowa student? Yes☐ No☐ If no, please indicate your current law school: Semesters completed by May 2015. ________________ 6. Are you a United States Citizen? Yes☐ No☐ Date of Birth: ______________ Male☐ Female☐ Note: Admitted students will be required to submit copies of their passport, green card, or other appropriate documentation prior to departure. Do you have a passport? Yes☐ No☐ Passport Number: __________________ Expiration Date: __________________ Full name as it appears on your passport: _________________________________ Country of Issue:_____________________ Emergency Contact Information Contact's Full Name: _______________________________________________ Relationship: ________________________ Address: _______________________________________________ City: _____________________ ST: _________ Zip: ____________ Email: ______________________________ Country: _________________________________________________ Phone: ______________________________ Course Selection (minimum of 2): ☐ Introduction to the Law of France (2 cr) Law in the Muslim World (2 cr) Building the State (2 cr) Please indicate command of French language, if any: __________________________________________ __________________________________________ Housing Preference: ☐ Two person studio ☐ One person studio—additional fee will be assessed. Please contact us at [email protected] for more information. If you wish to share an apartment with a specific individual, please provide his/her full name. Please indicate if this individual is a program participant or non-participant. Name:_______________________________________________ Program Participant: Yes☐ No☐ Do you smoke? Yes☐ No☐ UNIVERSITY OF IOWA FRANCE 2015 SUMMER STUDY ABROAD PROGRAM IN COMPARATIVE AND INTERNATIONAL LAW GENERAL CONDITIONS (1) This program is organized and administered by The University of Iowa College of Law in cooperation with various French institutions. The program is described at: http://www.law.uiowa.edu/academics/arcachon . (2) The right is reserved to cancel the program prior to departure or to alter it at any time if The University of Iowa College of Law determines that circumstances, including lack of sufficient enrollment, require such cancellation or alteration. In case of cancellation by the University full refund of all fees paid will constitute full settlement with the enrollee. (3) Neither The University of Iowa, its directors and employees, nor the Iowa Program and its sponsoring institutions or its program staff shall be liable for any loss, damage, injury, delay, irregularity, or additional expense arising from the acts or omissions of any providers of services or accommodations, or due to strikes, war, civil disturbances, weather, quarantines, sickness, government restriction or regulation, or from any other cause whatsoever. The program enrollee, by submitting this application, agrees to be bound by this statement of conditions, and waives any such claim against the aforementioned agencies and persons. (4) The enrollee further agrees as follows: (a) That, as a participant in the program, the enrollee will be required to purchase the health and evacuation insurance provided by the UI International Programs Study Abroad Office. You will receive information about this policy when you register with the UI International Programs Study Abroad Office. Further information on this policy may be found here. (b) The University of Iowa and the Iowa Program, along with its sponsoring institutions, and their directors and employees, are released from any and all responsibility and expense resulting from any health or accident problems incurred by the enrollee in transit to and from the program and during the program; (c) That the enrollee will have sufficient funds (a minimum of $1000 is recommended) over and above the cost of the program to maintain the enrollee and to provide for emergencies; (d) That all fees and deposits paid in connection with the program are nonrefundable after April 22, 2015, except in the case of certifiable personal medical emergency; (e) That the enrollee will not withdraw from the program after April 22, 2015, except as described in the preceding clause; (f) That the University of Iowa, the Iowa Program and its sponsoring institutions are not liable for the actions of any enrollee, or the results thereof; (g) That these general conditions apply to any and all family members who may accompany the enrollee for any portion of the program; (h) That the enrollee has read and understood the conditions set forth above and on the website. UNIVERSITY OF IOWA FRANCE 2015 SUMMER STUDY ABROAD PROGRAM IN COMPARATIVE AND INTERNATIONAL LAW RELEASE AND ASSUMPTION OF RISK (1) In consideration of my being permitted to participate as a student in the Iowa Program in France, operated under the auspices of The University of Iowa College of Law, as part of its academic curriculum, I do hereby release the University from liability and assume the risk as follows: (2) I understand that on rare occasions an eme rgency may develop which necessitates the administration of medical care, hospitalization, or surgery. Therefore, in the event of injury or illness to me (my spouse, son, daughter) I hereby authorize The University of Iowa, by and through its au thorized representative(s) or agen t(s) or the host institution coordinators or advisors in charge of said program, to secu re any necessary treatment, including the administration of an anesthetic and surgery. It is understood that such treatment shall be solely at my expense and I agree to reimburse the University for any expenses which it might suffer on account of said injury or treatment thereof. (3) I agree to release the University, its officers and employees, any agent, tour organizer, or arranger employed by the University, and the host and sponsoring school in Europe, from any and all claims and causes of action for damage to or loss of property, personal injury, illness or death, arising out of any travel or activity conducted by or under the control of the University with regard to the aforesaid Program. (4) I agree to indemnify and hold harmless the University, its officers, employees and agents, with regard to any claims and causes of action for damage to or loss of property, personal injury, illness, or death which I cause. UNIVERSITY OF IOWA FRANCE 2015 SUMMER STUDY ABROAD PROGRAM IN COMPARATIVE AND INTERNATIONAL LAW APPLICATION SUBMISSION By submitting this application, you are agreeing to the terms and conditions outlined on the GENERAL CONDITIONS and RELEASE AND ASSUMPTION OF RISK pages of this document. Your application will not be considered complete until the following are received: ☐ Completed application and course selection form. ☐ Letter of good standing from your home institution. (Not applicable to UI students.) ☐ $100 non-refundable application fee. Click here to pay online. (Save this document before clicking to pay or changes will be lost.) If you think that you will require special accommodations to participate in the program, please contact us at [email protected] BEFORE submitting this application. To submit your application online, save this completed form to your computer and email to [email protected]. Please be aware that the application will not be processed until the non-refundable deposit of $100 has been received. Click here to pay. (Save this document before clicking to pay or changes will be lost.) You will receive an email confirmation when your application is received, and when your application fee is received. To submit a paper application, print the completed form, in its entirety, and return to the address provided below. If you wish to pay the $100 application fee by check, please include a check, made payable to the University of Iowa College of Law, with your application. Please return your completed application form to: Kelley Winebold France Study Abroad Program University of Iowa College of Law 405 Boyd Law Building Iowa City, IA 52242-1113 Applications accepted beginning December 1, 2014. No applications or deposit payments will be accepted prior to this date.
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