Provost’s Office Accreditation Continuity of Instruction Deans and Department Chairs Institutional Review Board IRB Policies Student Achievement and Success Travel Study Approval Form Travel Study Approval Form NOTE: On-site Travel Study Leader is required for all FMU Travel Study programs. Approval Process Complete and submit application to Dean or Chair of the travel study leader’s academic department for review and recommendation. Once the Dean or Chair has reviewed and provided a recommendation, submit the application to the Provost’s Office for review and approval. Applications must be submitted to the Provost’s Office no later than October 15 for subsequent Late Spring, Summer and Fall courses, and by March 15 for subsequent Spring courses. Once receiving these approvals, an international travel study may be submitted for a funding request (REAL, PEAK, etc.) and be added to a course schedule. Post approval, instructor(s) will work with International Programs to insure compliance with all health, safety and passport issues. Students will be informed of their anticipated costs prior to committing to travel and must be given deadlines for submitting payment to the University. Deposits must be made in full with payment due not later than three months prior to departure date or course start date, whichever is earlier. Departments will keep all emergency contact information for students involved in an international travel study on file and readily available through the conclusion of the travel. Travel Study Leader Name * Travel Study Leader Name First First Last Last Travel Study Leader Email * Department BiologyBusinessChemistryEducationEnglish & PhilosophyFine ArtsHealth SciencesHistoryMass CommunicationMathematicsPhysics & EngineeringPolitical Science & GeographyPsychologySociologyModern Languages Departmental Dean/Chair Email * If you selected "Other Programs", Please put "provost@fmarion.edu" Important! When this form is submitted, an email will be sent to your Department Dean/Chair. This email will have a PDF attachment of the completed form. Upon receiving the email, your Dean/Chair needs to do the following: Review the completed form for approval. If approved, add an electronic signature to the bottom of the form where indicated. Forward the electronically signed PDF to the Provost for their approval. You are encouraged to let your Dean/Chair know to expect an email, and follow up with them once you've submitted the form. Is this travel study part of a course? * Yes No Proposal Title Is the Travel Study Leader the same as the professor of record? * Yes No Professor of Record Name Professor of Record Name First First Last Last Course Code Course Title Course Syllabus Upload Provide a draft syllabus for the travel study course(s) which details the required readings and on-site activities that the student will engage in for the course(s). Allowed file types are as follows: png, jpg, jpeg, pdf, doc, and docx. Drop a file here or click to upload Choose File Maximum file size: 314.57MB Proposal Description * Briefly describe the proposal, providing an overview of the trip itinerary, educational goals, etc. Program Itinerary Upload * Attach a detailed day-by-day itinerary for the travel portion of the course, including potential accommodation sites, cultural excursions, and transportation. This may be a draft document with a finalized itinerary to be submitted at a later date, at least one month prior to travel start date. Allowed file types are as follows: png, jpg, jpeg, pdf, doc, and docx. Drop a file here or click to upload Choose File Maximum file size: 314.57MB Travel Study Program Budget Please provide a detailed budget proposal, including costs to be borne by the student, using the fields below. Please note that no international transportation costs for students will be covered using university funds. this includes the domestic portion of travel. Students are expected to pay for their own meals unless the cost is included in the lodging expenses. Location(s) To Visit Course number or numbers (if applicable) and description of travel site curriculum and content. Program Start Date Program End Date FACULTY EXPENSES Travel Study Leader (Travel Study Leader is also the Professor of Record) Mode of Transportation Bus Train Plane Personal vehicle OtherOther Transportation Cost $.00 Baggage Fees $.00 If not applicable, leave bank or enter 0. Other Transportation Taxis Trains Boats Buses OtherOther Other Transportation Cost $.00 Other Transportation Fees $.00 If not applicable, leave bank or enter 0. Lodging Costs $.00 Cost per day x Number of days Faculty Expenses $.00 Ex: entrance fees, tours, guides, etc. Communications Expenses $.00 Ex: cell phone, wi-fi, etc. Instructional Supplies Costs $.00 If not applicable, leave blank or enter 0. Per Diem Costs $.00 Ex: meals, incidentals, etc. per day x number of days Visa/Country Entry/Departure Fees $.00 If not applicable, leave blank or enter 0. Other Costs $.00 TOTAL TRAVEL STUDY LEADER COSTS Proposed Source(s) of Funding ADDITIONAL FACULTY COSTS Will there be additional faculty? * Yes No Additional Faculty Number of Additional Faculty Members Complete the following based on the costs per faculty member. Mode of Transportation Bus Train Plane Personal vehicle OtherOther Transportation Cost $.00 Baggage Fees $.00 If not applicable, leave bank or enter 0. Other Transportation Taxis Trains Boats Buses OtherOther Other Transportation Costs $.00 Other Transportation Fees $.00 If not applicable, leave bank or enter 0. Lodging Costs $.00 Cost per day x Number of days Faculty Expenses $.00 Ex: entrance fees, tours, guides, etc. Communications Expenses $.00 Ex: cell phone, wi-fi, etc. Instructional Supplies Costs $.00 If not applicable, leave blank or enter 0. Per Diem Costs $.00 Ex: meals, incidentals, etc. per day x number of days Visa/Country Entry/Departure Fees $.00 If not applicable, leave blank or enter 0. Other Costs $.00 TOTAL ADDITIONAL FACULTY MEMBER COSTS STUDENT EXPENSES Travel & Program Costs NOT PAID BY STUDENT (The following are expenses typically covered under PEAK, REAL or other funding) Accomodations List the following information for all lodging establishments on the itinerary. Name of Establishment (Lodging 1) If not applicable, leave blank. Number of Nights Rate Per Night, Per Person $.00 Total Per Student Cost Name of Establishment (Lodging 2) If not applicable, leave blank. Number of Nights Rate Per Night, Per Person $.00 Total Per Student Cost Name of Establishment (Lodging 3) If not applicable, leave blank. Number of Nights Rate Per Night, Per Person $.00 Total Per Student Cost Name of Establishment (Lodging 4) If not applicable, leave blank. Number of Nights Rate Per Night, Per Person $.00 Total Per Student Cost Name of Establishment (Lodging 5) If not applicable, leave blank. Number of Nights Rate Per Night, Per Person $.00 Total Per Student Cost Ground Transportation Costs for Course-Related Activities, Per Student $.00 If not applicable, leave blank or enter 0. Entrance & Tour Fees, Per Student $.00 If not applicable, leave blank or enter 0. Visa and Country Entry/Departure Fees, Per Student (If applicable) $.00 If not applicable, leave blank or enter 0. Proposed source(s) of funding $.00 If not applicable, leave blank or enter 0. Other Costs, Per Student $.00 If not applicable, leave blank or enter 0. Proposed Source(s) of Funding TOTAL TRAVEL & PROGRAM COSTS PER STUDENT Other Student Costs (Student-Paid) Students will need to budget for items not included in the program fee or covered by other funding sources. The list below provides expenses students may incur during the program. Please ensure that this section is as accurate as possible to ensure that students can budget correctly. Transportation Cost, Per Student $.00 Ex: bus, train, plane, personal vehicle, etc. Meals, Per Student $.00 Health Insurance, Per Student $.00 Personal Expenses, Per Student $.00 Ex: toiletries, special clothing, souvenirs, etc. Local Transportation, Per Student $.00 Ex: taxis, buses, etc. Books, Equipment, & Supplies, Per Student $.00 Visa/Country Entry/Departure Fees, Per Student $.00 If not applicable, leave blank or enter 0. Other Costs, Per Student $.00 Other Costs, Per Student $.00 Tuition, Per Student $.00 TOTAL ADDITIONAL COSTS PER STUDENT (STUDENT-PAID) Deadline for Student Deposit Approval Signatures This section is to be completed by the Department Dean/Chair and Provost once this form is submitted. Dean/Chair Date Provost Date Captcha Submit If you are human, leave this field blank.