Dr. Erin Moore Department of Anthropology

Office: KAP 340

Anthropology 301, D Clearance, 2018

Application to Program

The Global Performance of Healing,PORTUGAL and Spain 2018

Travel approximately May 18-June 15th.

This is a Maymester Course for the Spring 2018

We will fly in to Lisbon, train to Porto and then walk in to Spain, Santiago and on to Finesterre on the coast.

Please sign the following and put a hard copy under my door at KAP 340.

Print Name: ______

1. Submit a copy of your passport pagethat has your picture.

2. I understand that I am responsible to:

Get a passport that will be valid for 6 months after our departure from Spain.
Date of expiration of my passport:______
Passport no. ______
Country of Passport:
If you travel on another country’s passport, then you may need a visa. It is your obligation to find out if you need a visa for a non-U.S. passport. (U.S.passport does not need a visa).

HEALTH: I will be required to pay for USC health insurance to cover the time of this course. coordinates this. It is about $96. for those who opted out of USC insurance. (Erin organizes this for you, You pay).

Due with this form. I will be required to place a $400. non-refundable deposit for the course. The University will bill you when you give me this form.

When we have other expenses before leaving (ie. trains and hotels), you will be also responsible for these if you drop out before we leave.

Are there any dates on the syllabus that you cannot make, any exceptions to the terms above?...... if yes, pls. explain below.

______

9. Trip Cancellation Insurance Statement I hereby acknowledge that I’ve been encouraged to purchase trip cancellation insurance as a precaution to any postponement or cancellation of the Maymester 2018 trip, Anthropology 301.

10. I acknowledge that I got a copy of the University refund policy.

11. I will have to arrange my own housing during the length of the USC campus based classes.

Confidential Medical Information:

Do you have a required special diet (explain): ______

Allergies (drugs, food, plants, asthma: ______

Medicines I am taking (besides a contraceptive): ______

Past surgeries, athletic injuries (the hike is strenuous, past injuries can give you trouble):______

Past hospitalizations: for what condition and dates: ______

Are you currently under the care of a doctor/psychologist/psychiatrist (other than yearly check-ups, birth control, or acne) ______

Have you ever taken a leave of absence from any school for any reason?

Any other information I should know about concerning your health?

Signed:

Date:

FOR THE UNIVERSITY DATA SHEET. PRINT ANSWERS VERY CAREFULLY or type it out.

Print Name:

Date of Birth:

Student I.D. no.:

Phone(s):

Email:

Major:

Citizenship:

Grade levelon May 18th (after Spr. Graduation):

USC address:

Health Insurance:

Emergency contact Information: of Parent or Guardian

Name,

Address,

Phone: with area code.

Background:

Travel experience: alone or with family?

See the deadlines for dropping the class on the website.

Sign required forms and return to me before D clearance and registration.

There are other forms that the University requires signed: Print these forms and sign, give to me with this application.

Know Before You Go Informed Consent Form
This document serves as a guide for students with different physical or learning abilities, those with medical conditions, and those with psychological issues in order to assist them in making an informed decision on selecting an overseas location that is appropriate for them.

Medical Treatment Authorization
This form allows USC representatives to authorize medical treatment for a student who is incapacitated and unable to make such decisions on their own.

Travel Release
This is USC’s standard release form to be used by all overseas programs. This release was prepared by the USC Office of the General Counsel. If your department wishes to include additional information on your release forms, this should be reviewed with the Office of the General Counsel before making any revisions.