Dear Program Proposer:

Attached hereto is the Embedded Education Abroad Checklist which is to be used starting in the Fall 2006. This Checklist will provide general information about programs going abroad as well as information on Program Implementation (i.e., emergency contact information, Risk Management, Health Insurance, etc.).

As part of the approval/recommendation process for faculty-led International Programs, please fill out Part A of the Embedded Education Abroad Checklist and return an electronic copy to the Chair of the International Studies Review Committee (Dr. Deborah Gill, ). Once the Chair of the ISRC receives the Checklist, the program will be officially approved by the ISRC. Until that time, the proposed program will be pending and not fully approved. This must be done four to six months before the program is to commence.

No later than two weeks before the trip is to commence the original hard copy of the Checklist (with both Parts A and B filled out—along with the required attachments) should be sent to the address stated on the form and hard copies should be forwarded on to Dr. Nancy Herron.

If you have any questions, please do not hesitate to contact Dr. Deborah Gill () or by phone at 814-375-4783.

Sincerely,

Deborah Gill

Deborah Gill, Ph.D.

Associate Professor of Spanish

Pennsylvania State University, DuBois

College Place

DuBois, PA 15801

(814) 375-4783

Email:

cc: Dr. Nancy Herron

EMBEDDED EDUCATION ABROAD PROGRAMS CHECKLIST

(Required per Policy TR13 in Travel Section of Policy Manual)

In order to minimize institutional risk and to ensure compliance with University Policy TR13, Penn State Education Abroad asks faculty and departments organizing and/or sponsoring international excursions which are supplemental or embedded within an academic course to submit the following information and necessary documentation, as specified. Please direct questions to Penn State Education Abroad at 814-865-7681.

SUBMIT DUPLICATE COPIES OF ALL DOCUMENTATION TO:

  1. Sponsoring Dean or Chancellor
  2. ATTN: Associate Director, Education Abroad, 410 Boucke Bldg., University Park, PA 16802

SECTION A: PROGRAM DEVELOPMENT

SUBMISSION REQUIRED 4-6 MONTHS PRIOR TO PROGRAM DEPARTURE.

All embedded education abroad programs must be reviewed by Penn State Education Abroad (working in consultation with the Penn State Risk Management Office). Section A must be submitted at least 4-6 months prior to program departure but not before securing program approval by the Dean or Chancellor of the sponsoring Penn State college or campus.

1.BRIEF DESCRIPTION OF PROGRAM:

2.SPONSORING COLLEGE OR CAMPUS:

Name of Sponsoring College or Campus:
Department/Division:
Name of College Dean or Campus Chancellor:
Date Approved by Dean or Chancellor:

3.FACULTY LEADER/ PROGRAM COORDINATOR:

Name of Faculty Leader (person in charge):
Faculty Leader Contact Info. (Tel/Email):
Name of Program Coordinator (if different):
Program Coordinator Contact Info. (Tel/Email):

4.PENN STATE COURSE INFORMATION:

Course Number & Title:
Number of Residential Credits Offered:
Additional Course Number & Credits Offered
(through participation in international excursion):
Semester & Year Offered:
Course Specific Website (if available):

5.INTERNATIONAL EXCURSION:

International Destination(s):
Dates of Excursion:
Names of All Participating Faculty/Staff/TAs:
Expected Number of Participants:

6.ACADEMIC PROGRAM INFORMATION:

a. / Is the international excursion required?
b. / If required, and no additional credits are earned abroad, are contact hours of the residential course reduced? If so, how many?
c. / If the international excursion is optional and earns credit, what is the method of evaluation?
d. / Are Penn State students who are not enrolled in the residential course able to participate in the international excursion (e.g., students in the same course at another campus, students who have taken the course previously, or students in courses with similar academic content)?

7.ADDITIONAL PROGRAM INFORMATION:

a. / Are you chartering any aircraft or watercraft? [If so, contact the Risk Management Office immediately for specific insurance requirements. Tel. 814-865-6307]
b. / Is an external agent to Penn State University involved in the logistics or in hosting the excursion? If so, please provide the name and contact information for this agent.
c. / Are non-Penn State students permitted to join the international excursion as full participants (e.g., community members, alumni, family)?
[If so, contact the Risk Management Office immediately. Tel. 814-865-6307]

8.ADDITIONAL COMMENTS (IF ANY):

SECTION B: PROGRAM IMPLEMENTATION

SUBMISSION REQUIRED NO LATER THAN 2-3 WEEKS PRIOR TO PROGRAM DEPARTURE

All embedded education abroad programs must be reviewed by Penn State Education Abroad (working in consultation with the Penn State Risk Management Office). Section B must be submitted at least two weeks prior to program departure, but only if Section A has been approved by the Dean or Chancellor of the sponsoring Penn State college or campus and reviewed without complication by Penn State Education Abroad. (Section A should be re-submitted together with Section B.)

1.EMERGENCY CONTACT INFORMATION

Name of Faculty Leader (primary contact):
Primary Telephone Number (+ country code):
Secondary Telephone Number (+ country code):
International Address(es):
Email:
Name of Secondary Contact:
Telephone Number (+ country code):
International Address(es):
Email:

2.HAVE SAFE, ACCESSIBLE HOUSING ARRANGEMENTS BEEN MADE FOR ALL PARTICIPANTS?

YES / NO / Please Describe:

3.HAVE FIELD TRIPS (IF ANY) BEEN REVIEWED FOR HEALTH AND SAFETY ISSUES?

YES / NO / Please Describe:

PLEASE REVIEW THE FOLLOWING:

  • Center for Disease Control [http://www.cdc.gov/travel/]
  • Travel Warning and Consular Information [http://travel.state.gov/]
  • University Health Services [http://www.sa.psu.edu/uhs/]
  • Risk Management Office [http://www.controller.psu.edu/Divisions/Riskmanagement/]
  • Student Insurance Office [http://www.sa.psu.edu/uhs/basics/insurance.cfm]

4.HAVE ALL WRITTEN AGREEMENTS FOR CONTRACTED PROGRAM SERVICES BEEN APPROVED BY PENN STATE PURCHASING SERVICES OR SIGNED BY AN ASSISTANT TREASURER IN ACCORDANCE WITH POLICY FN11? [If not, contact the Risk Management Office immediately, Tel. 814-865-6307]

YES / NO / N/A

5.HAS THE REQUIRED HTH LIFE AND HEALTH INSURANCE POLICY BEEN PROCESSED FOR ALL PROGRAM PARTICIPANTS? [Regardless of other insurance coverage students may have, all are to be enrolled in this HTH insurance plan. Faculty and staff are not eligible to enroll in the plan. Those students who already have HTH insurance, however, are exempted from this requirement (i.e. international students, graduate students with assistantships, etc). All insurance documentation and payment should be submitted no less than two weeks prior to departure.]

YES / NO

6.DO ALL PENN STATE FACULTY AND STAFF HAVE EITHER THE UNIVERSITY’S OPTIONAL LONG-TERM DISABILITY (LTD) COVERAGE OR THE UNIVERSITY’S OPTIONAL VOLUNTARY ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE (VADD) INSURANCE AND DO THEY CARRY PROOF OF THIS COVERAGE? [LTD and VADD cards for international travel are available from the Employee Benefits, http://www.ohr.psu.edu/benefits]

YES / NO
  1. REQUIRED ATTACHMENTS (VERY IMPORTANT):

(a) STUDENT ROSTER & EMERGENCY CONTACT INFORMATION. Attach a student roster with the following information for each participant: student name, ID number, and the name of an emergency contact, including the contact’s relationship to the student and the contact’s phone number. The emergency contact should be someone who will take responsibility for overseeing the student's evacuation or repatriation to the student's home country in the event of an accident, illness, or even death. Normally the contact will be a spouse or partner, parent or legal guardian, or sibling.

(b) TRAVEL LOGISTICS. Attach means of transportation and flight numbers, how participants are traveling to and from airports or similar, and scheduled departure and arrival times. If participants travel on their own to and from departure and/or arriving airports, please so indicate.

(c) TRAVEL ITINERARY. Attach a complete travel itinerary of the program.

POLICY TR-13 REQUIRED AUTHORIZED SIGNATURES

We certify that the information we have submitted is accurate to the best of our knowledge. We also agree that this program is in compliance with Penn State's academic and administrative policies, including those concerning risk management and mandatory health insurance for students and faculty on short-term international programs.

Sponsoring College or Campus (Dean or Chancellor)Faculty Leader/ Program Coordinator:

______Date______Date______

SignatureSignature

______

Printed Name/Title Printed Name/Title