CoB International Program

Outgoing Student Document

Name: __________________________________________________________

Exchange site: ______________________  Semester/year abroad: ________

Signature: ______________________________________  Date: __________

Please read the following documentation and initial where indicated.

Participant Statement of Understanding                                         Initials: ______

I, the above named student, a participant in the College of Business Exchange Program, attending the above named school, in the above named semester, understand that I am responsible for the following and approved courses as listed on the Prior Approval of Transfer Credit form.  Once at the host institution, any deviation from the courses listed on the prior approval form must be immediately forwarded to Dr. Mainuddin Afza by e-mail (mafza@bloomu.edu) to obtain approval for courses, otherwise, the course(s) will not be accepted for transfer.

I further understand that I am responsible to maintain full-time status (12 credits – 4 courses) while studying at the host institution.  In addition, I understand that if I have any financial aid, I am required to ear 24 credit hours per year in order to be eligible for financial aid.

Records Release Consent                                                              Initials: ______

I, the above named student, hereby give consent to Bloomsburg University to release any and all records it may have in its possession to the above named school (exchange school) if such records are requested and required in order to probe my qualifications to enter into the exchange program or for other valid educational purposes.  I realize that such records may include and not be limited to academic, health, and disciplinary records, as well as my student’s identification/social security number for identification/security purposes, this release will expire at the end of my student exchange with the affiliated entity.

Each university shall protect the confidentiality of student records such as directed by respective country/stat laws and regulations and shall release no information absent written consent of the student unless required to so by law or as dictated by the terms of this Agreement.

Medical Emergency Release Consent Form                                  Initials: ______

I, the above names student, in the case of a medical emergency where I am unable to provide competent consent to medical treatment, hereby authorized by the host academic institution named above (exchange university) to give consent for medical treatment on my behalf.  All ordinary and extraordinary medical measure are to be taken in regards to medical treatment. 

I confirm that any and all not paid by my medical insurance are my responsibility and I shall indemnify and hold harmless both my host institution and home institution form any suit in association with the decision as to emergency medical treatment.

Commonwealth of Pennsylvanian Laws and Bloomsburg University Policies in Regard to CoB Programs                                                                          Initials: ______

I, the above named student, understand that the codes of student conduce in place at Bloomsburg University and the laws of Commonwealth of Pennsylvania apply to the exchange contract.  Any violation of relevant BU policies and/or laws of the Commonwealth of Pennsylvania while attending any of the exchange universities abroad will result in immediate removal from participation in exchange program and revocation of all allotted privileges without any compensation.  In addition, under suck circumstances, Bloomsburg University and/or appropriate authorities will act accordingly. 

I also understand that I must observe the laws of the country and the policies of the university that is the site of my exchange.  Any violation of these laws and policies is dealt with accordingly.  In addition, it will result in immediate removal from participation in exchange program and revocation of all allotted privileges without any compensation.