GLOBAL IMMERSION PROGRAMS Registration and Course Information MGMT656-003 Fall 2014 Please read this registration information fully and carefully to avoid confusion with respect to registration, attendance, cancellation policies, etc. Jakarta Bali Kuala Lumpur Singapore GIP TIMELINE / DELIVERABLES • Tuesday, September 30 - Registration forms due to the MBAPO by 5pm for GIP lottery • Wednesday, October 1 - Lottery participants receive notification of their GIP enrollment status. Any student who wins a seat in the lottery will automatically enrolled in the course and billed the program fee. • Week of October 13 - Students should begin visa processing, if applicable. All visas should be obtained before Thanksgiving break. • Monday, October 20 - Orientation Meeting & SHS Consultation (4:30-6:30pm, room SHDH 1203) • Thursday, October 23 - Last day to drop GIP at 50% financial penalty or find a replacement for your spot. Any drops after 5pm will result in a forfeit of 100% of the program fee. No exceptions! No new participants (or replacements) are able to join the program after this date. • Thursday, October 23 - Roommate selections and “Registration Details” due. Follow the instructions on Canvas to complete these tasks. Any student who does not select a roommate will be randomly assigned one. • Monday, October 27 - Faculty Lecture (4:30-6:30pm, room SHDH 1201) • Monday, November 3 - Faculty Lecture (4:30-6:30pm, room SHDH 1201) • Monday, November 10 - Faculty Lecture (4:30-6:30pm, room SHDH 1201) • Monday, November 17 - Faculty Lecture (4:30-6:30pm, room SHDH 1201) • Monday, November 24 - NO GIP CLASS • Monday, December 1 - Faculty Lecture (4:30-6:30pm, room SHDH 1201) • Thursday, December 4 - Deadline to book individual flights and report itinerary, turn in Company Profile Assignment, upload Resumes, and confirm participation through the Global Registry. Follow the instructions on Canvas to complete these tasks. • Monday, December 8 - Pre-Departure Meeting (4:30-6:30pm, room SHDH 1201) • Thursday, December 11 - Visa and passport copies due. Follow the instructions on Canvas to complete these tasks. • Sunday, December 28 - Saturday, January 10 - Immersion Experience • Monday, January 12 - Company Visit Summaries due. Follow the instructions on Canvas to complete this assignment. • Monday, February 9 - Final paper due to MBA Program Office. Follow the instructions on Canvas to complete this assignment. INTRODUCTION Wharton Global Immersion Programs (GIPs) are elective, half credit courses designed to provide a highlevel survey of the economic, cultural and geo-political drivers behind regions integral to the global economy. GIPs are designed with a focus on the student and include opportunities for participant input in shaping the experience. They are recognized as unique opportunities, providing students with exclusive access to high-level business, cultural and political leaders. Since its inception in 1993, more than 2,100 Wharton MBA students have participated in the GIP. Many have returned saying it was one of the highlights of their Wharton careers. This year, the Fall 2014 Southeast Asia GIP (MGMT656-003) will travel to Jakarta, Bali, Kuala Lumpur, and Singapore. On campus sessions take place during quarter 4. The immersion experience (study tour) will take place between December 28, 2014 - January 10, 2015. Academic Study The Middle East Global Immersion Program begins with a full quarter of on-campus sessions designed to establish a foundational knowledge of the region while introducing relevant topics in business, government, politics, culture, and safety, which are conducted by faculty and staff area specialists. Along with a series of faculty lectures, co-curricular sessions may be included in preparation for group travel. For example, during one session, professionals from Student Health Services will provide an important health and safety overview and travel health documents to inform students of necessary immunizations and other health and safety resources. Students are responsible for obtaining the requisite medical clearances distinct to the region. Students are also provided information on business etiquette, language and cultural expectations. These required sessions will take place on Mondays, 4:30-6:30pm, in Quarter 2. In order to participate, you must have this timeslot available in your course schedule. Our scheduling system will not allow a time conflict . If you have a class conflict, you will be ineligible to register for the GIP. Immersion Experience The immersion experience component takes place between December 28, 2014 and January 10, 2015. The program will travel to four distinct places: Jakarta, the capital of Indonesia, and largest city in Southeast Asia; the beautiful island of Bali; Kuala Lumpur, cultural melting pot and capital of Malaysia; and lastly, the citystate of Singapore, one of the world’s major commercial hubs. Student participants are required to be present for the entirety of the immersion experience. Students may arrive any time on Sunday, December 28 and they may depart any time on Saturday, January 10. Note: Students leaving from the United States will need to depart by December 27. Sunday 28 Monday 29 Students arrive in Jakarta 4 Jakarta 5 Kuala Lumpur Tuesday 30 Jakarta 6 Kuala Lumpur Wednesday 31 Bali 8 Singapore Friday 2 Bali 7 Kuala Lumpur Thursday 1 Bali 9 Singapore Saturday 3 Kuala Lumpur 10 Singapore Students depart The immersion experience will include several different types of experiences: Organizational Visits: This portion of the program is designed to introduce students to the region through direct interaction with locally based organizations. Through meetings with business, government and cultural leaders, students experience unique aspects of business in the region, better realize how market forces influence decision making, and explore potential concerns and opportunities for continued growth. Visits to production facilities as well as corporate headquarters reveal how management decisions directly affect operations and personnel. The government’s influence on an economy can vary dramatically between countries. Students may explore the interaction between the public and private sectors by meeting with officials from national and regional regulatory agencies. Through these experiences, students receive an introduction to government commercial policy and its effectiveness. Cultural Experiences: The immersion experience is punctuated by opportunities to explore regional culture, thus building toward an appreciation of its influence on the society. Cultural experiences often take the form of planned group events including excursions to areas of cultural significance or interactions with Wharton alumni. Cultural experiences introduce students to societal norms without the constraint of prescribed expectations. In this safe environment, students are encouraged to learn through exploration. During the Southeast Asia 2014 tour, the following tours are included in the program fee: Kuala Lumpur City Tour (including Petronas Twin Towers), Batu Caves Tour, Malacca Tour, Singapore City Tour, and NYE party in Bali. Reflective Learning Reflective learning is achieved through faculty-led group discussions designed to draw forth and disseminate valuable insights before and during the immersion experience. Additionally, students are called to participate in several written assignments, which culminate in a final reflective piece. • Company Profiles: Each student is expected to function as a member of a team and produce a profile of a company of regional significance, usually one to be visited during the study tour. Company Profiles provide the class with crucial background about the companies they are to visit, including relevant trends and issues. Completed profiles will be compiled in a program brochure. Students may be called upon to offer a brief presentation of their profile during the study-tour. • Visit Summaries: Each student is expected to function as a member of a team and produce a 1-2 page summary of an assigned organizational or cultural visit. These summaries serve as a valuable resource while preparing the final paper. They must be posted to the GIP Canvas site prior to the conclusion of the immersion experience. • Reflections: During the immersion experience, students will participate in a series of reflective discussions designed to draw forth and disseminate valuable insights. Students are expected to participate by sharing their interpretation of group and personal experiences while reflecting on those of others. • Final Written Assignment: The final paper serves as a capstone for the experience. It is written by an individual participant and focuses on a singular theme pertaining to the GIP experience, drawing upon the knowledge obtained during academic study. The paper requirement is typically 2000-2500 words in length and is due approximately a month after returning from the immersion experience. Please refer to the Timeline of Deliverables for specific due dates. Grading The GIP course may only be taken on a Pass/Fail basis. For this reason, it does not count toward the 1cu of P/F permitted each semester. Each component of the course has a specific point value. Each student may lose 10 points and still pass the course. Students who lose 11 points or more will fail the course. There is no partial credit. The points system permits some flexibility for extracurricular activities, travel, homework, recruiting, etc. Unavoidable situations such as illnesses or family emergencies which may cause a participant to lose more points than allowable must be discussed with the program administration prior to the absence. Excuses provided after an absence has occurred may not be accepted. Missing an element of the course deemed indispensable may result in immediate failure. Flexible Rigid Orientation Meeting 4 points Company Profile 11 points Health Briefing 4 points Visit Summary 11 points Each Faculty Lecture Pre-Departure Meeting 6 points 6 points Final Paper Org. Visits/ Reflections 11 points 11 points Role of the Faculty and Staff Faculty Specialists from Wharton, the University of Pennsylvania and its affiliated institutions will conduct the oncampus sessions. Adrian Tschoegl, Lecturer, Management, will evaluate the written assignments. A member of the faculty will travel with the group to lead reflections and assist in the learning process. Administration Amy Miller – Director, Global Immersion Programs : The GIP Director is responsible for decisions pertaining to the programs’ design, delivery and financial aspects. She is the primary liaison to the faculty and administration and is responsible for the academic integrity of the course. The GIP Director is responsible for enforcing disciplinary action. She also manages the planning teams, in which capacity he assists in connecting Program Directors and Student Coordinators with company and alumni contacts. [email protected], 215-573-9336 – 300 Huntsman Hall Christine Sweeney – Coordinator, Global Immersion Programs : The GIP Coordinator serves as the primary point of contact for students. She manages timelines, registrations, logistics and marketing. The GIP Coordinator is responsible for disseminating information to students, GIP planning team members and travel providers. She is the primary liaison between the students and travel providers and is responsible for the production of all course-related materials. [email protected], 215-898-5623 – 300 Huntsman Hall The Planning Team Program Director Program Directors work in concert with GIP Administration and Student Coordinators to schedule visits with organizations integral to the socio-economic climate of the region of study. In this capacity, directors: • Review and respond to student-contributed company/industry suggestions • Assess the feasibility/value of visits • Liaise with faculty, alumni, administrators and students to choose and plan visits • Ensure that visits present a well-rounded view of the country and its business environment The director’s most important role during the travel experience is working to ensure group safety. To the extent possible, directors have an operational knowledge of participants’ whereabouts at all times and know how to contact individual participants and requisite services in the event of an emergency. Directors enforce the trip’s attendance policies and are responsible for communicating and managing the itinerary. Directors are responsible for initiating student-led company briefs prior to the visit and leading discussion afterwards. During visits, directors introduce the group, exchange business cards and conclude each visit with a public “thank you” and presentation of gifts on behalf of the students, GIP and Wharton. Program Coordinator(s) Student Coordinators are expected to represent the voice of the student participants. They work in concert with GIP Administration and Program Directors to schedule visits that deepen participants’ understanding of the socio-economic climate of the region. In this capacity, coordinators: • • • Assess the feasibility of visits Contribute to the conversation with regard to the value of visits Liaise with alumni and students to choose and plan visits Coordinators assist in determining the logistical details of visits and are familiar with the organizations they will be visiting. Coordinators draw from their own personal expertise and that of their network to furnish suggestions with regard to visits as well as restaurants, bars, and other cultural attractions in each location. During the immersion experience, student coordinators are available to participants at all times. Coordinators serve as interpreters as necessary. They are also expected to explain and anticipate (to a reasonable degree) cultural nuances that may impact the group’s ability to negotiate a situation or deepen their awareness. Coordinators are responsible for arranging optional social activities for participants throughout the trip. Fee Information 2014 Program Fee: $3,700 Tuition covers the academic costs associated with the GIP. An additional program fee is assessed to cover travel-related expenses. All students must pay the program fee prior to departing for the immersion experience. Assuming a minimum of 20 participants, the additional program fee will be announced during pre-term. The program has a maximum enrollment of 35 students. Faculty, Directors, and Coordinators are not included in this maximum. This fee includes: • • • • • • • • • • • • Intra-trip travel - travel between cities once the group has arrived in the region Group transportation to included activities and organizational visits Overnight accommodations - GIP participants are required to stay at the group’s hotel. The program fee is based on double occupancy (Single occupancy requests must be made in advance of the roommate selection deadline.) Activities and excursions as noted in the itinerary (“Optional” excursions not included) Breakfasts Opening and Closing Receptions Some staff travel Internet access throughout the program Related fees (interpreters, guides, etc.) Tips for guides, drivers & interpreters arranged for by the program Airport Taxes Travel Agent services The fee does not include: • • • • • • Inter-program airfare (travel to and from the region) - Because the GIP starts and ends in different cities, it is often difficult for students to take advantage of roundtrip flight packages. Students have found kayak.com’s “multi-city” feature helpful in bundling flights. Meals & beverages (except breakfasts) Travel insurance - It is highly recommended that students purchase travel insurance to cover their interprogram airfare and program fee. The School will only reimburse the program fee if the School cancels the program. The University recommends using TravelGuard. Travel documents (passports, visas, photos, etc.) - Advance entry visas may be necessary depending on the country to be visited and the participant’s citizenship. Visa fees are not included in the program cost and learning about and obtaining the requisite visas is the responsibility of the participant. The GIP Administration is able to provide letters of participation upon request. • Health insurance & immunizations - The University contracts with International SOS to provide students, faculty, and administrators with worldwide access to emergency international medical, security, and travel assistance. This is not a health care service, but instead an emergency assistance provider. The University recommends purchasing HTH, which offers an international health care plan that is subsidized by Penn: http://www.hthstudents.com/ge.cfm?ac=HCW-20168 NOTE: Student health insurance offered by the University of Pennsylvania may not be accepted as valid payment for medical services in many GIP destinations. Participants with UPENN’s student health insurance who avail themselves of medical services while travelling abroad will be expected to pay upfront for services rendered and submit a reimbursement claim after services have been rendered. Individual recreation, optional tours, and/or side trips All other services not enumerated in this document Past participants have recommended at least $500 in personal funds per two weeks of travel. Actual costs vary depending on one’s spending habits and may be impacted by the type, manner and quality of chosen recreational experiences; additional travel; exchange rates; etc. Loans Student loans may be available to those enrolled in the Global Immersion Program (GIP). Loan Funding may be applied to cover the cost of the GIP fee, the estimated cost of international travel and $500 per two weeks of travel for personal expenses. Student loans may be possible only if the GIP is required for graduation. Second years who have earned 19cu prior to completion of the GIP are not eligible for student loans. Students borrowing funds are strongly encouraged to submit your loan applications early, as disbursal may take 4-6 weeks. Please note, students will not be able to apply for additional loans until after being formally enrolled in the course. For more information, contact the Tammy Carter ([email protected]). Waitlist Students on GIP waitlists will not incur a financial obligation unless they accept a seat, at which time the GIP program fee will be billed directly through SFS and the same deadlines listed on the deliverables page will apply. Registration and Billing Registration for this course takes place outside of Course Match via a lottery. To register for the lottery, please sign and return the attached forms to the MBAPO by 5:00pm on September 30. Students who are interested in more than one program within a semester, may submit the respective forms for both programs however, it is only possible to win one seat. Students must note on the registration forms which course they prefer in the event that they win both. There will not be an opportunity to weigh both programs after the lottery is complete. Students may withdraw their forms from the lottery any time before 5:00pm on September 30. After 5:00pm on September 30 a lottery will be conducted. All students who win a seat in the lottery will immediately be enrolled in the course and held financially responsible for the program fee, billed to the student bursar bill. Students will receive notification of their enrollment status by 12:00pm on October 1. The GIP fee will be billed directly through Student Financial Services (SFS) and will appear on students’ University bills. This charge will be billed immediately following enrollment. All GIP program fees must be paid prior to departure on the study tour. Participants with outstanding fees at the time of departure will not be permitted to travel with the GIP or participate in the program. Note: Payments received toward outstanding bursar bills are applied against the oldest charges first - students must be paid in full through GIP charges in order to participate in the immersion experience. Questions regarding billing may be addressed to the Student Accounts Office at 215.898.4212 Cancellations The Wharton School reserves the right to cancel any immersion program for any reason prior to the date of departure. In such cases, the Wharton School will not assume the cost of individual travel arrangements made by participants. For this reason, it is highly recommended that travel insurance be purchased. • If the Wharton School cancels any immersion program for any reason before the date of departure, all monies received for the program fee will be refunded to program participants. • If a student wishes to withdraw his/her registration forms from the lottery before 5:00pm on September 30, 2014 there is no financial penalty. • By executing and submitting the registration form by 5:00pm on September 30, 2014 the student agrees that if awarded a seat in the lottery, hence securing his/her space on the program, he/she is liable for 50% of the program fee. This portion of the fee is non-refundable. • If the participant cancels after 5:00pm on September 30, 2014 and another student is able to commit (add course via Spike, sign and submit waiver forms) to taking her/his place by 5:00pm on October 23, 2014, the participant cancelling will not be charged for the program and the newly enrolled participant will assume the costs and expectations as outlined in the registration packet. • Replacements are only permitted through October 23, 2014, not after. • If the participant cancels after 5pm on September 30, 2014 but before 5pm on September 30, 2014 and has not found a replacement, she/he will receive a 50% refund if the program fee has already been paid. If the fee has not been paid the charge to the participant’s account will be adjusted down by 50%. In these circumstances, the participant will be responsible for 50% of the program fee regardless of whether or not the bill has been paid at the time of cancellation. • If a participant cancels after October 23, 2014, the entire program fee is owed and/or forfeited. For persons who depart early due to medical or bereavement reasons, there is no guarantee of a refund but every effort will be made to recover all remaining accommodation and travel expenses. NOTE: Circumstances surrounding the potential of said refund may not be known until after the program’s conclusion. Group Expectations The Global Immersion Program is intended to be a comprehensive learning experience. Sessions prior to departure and during the immersion experience are designed to fulfill the academic requirements of the course while introducing students to regional culture and accounting for the safety and expectations of the program’s participants. During the immersion experience, except in the case of family crisis or medical emergency, students are required to participate in the entirety of the planned program. Potential participants who cannot commit to the entirety of the immersion experience and/or on-campus sessions should not register. Traveling with a large group over several weeks demands a keen understanding of group dynamics. Special care should be given to balancing the demands of the individual and the needs of the group. This is especially pertinent when traveling in an unfamiliar environment. Participants’ willingness to participate constructively in group discussions/decisions enhances the quality of the program. Students who choose not participate or have a strongly negative or subversive influence on the group’s dynamic may be asked to leave the group in which case they would forfeit the program fee and fail the course. The Wharton School, through its authorized representatives, reserves the right to expel from any immersion program participants whose conduct is detrimental or dangerous to the group or the good name of the Wharton School. Any cancellation fees or additional costs incurred by a participant as a result of expulsion are the responsibility of the participant. No refunds or program fee reductions will be made and the participant will receive a failing grade (F) for the course. Further Information If you have any questions about the Global Immersion Program, please stop by the MBA Program Office in 300 JMHH or contact: Amy Miller Director, Global Immersion Programs Email: [email protected] Phone: 215-573-9336 Christine Sweeney Coordinator, Global Immersion Programs Email: [email protected] Phone: 215-898-5623 CODE OF CONDUCT Participants in Wharton’s Global Immersion Program represent not only themselves but also the Wharton School and the University of Pennsylvania. Public errors in judgment and/or inappropriate conduct may result not only in repercussions for an individual but also risk jeopardizing the safety and security of the group and causing irreparable damage to the Global Immersion Program, the Wharton brand and the good reputation of the University of Pennsylvania. As participants’ behavior will not be perpetually monitored it is incumbent upon the individual to consider the potential for the negative implications associated with unacceptable or dangerous behavior. Participants who engage in behavior deemed unacceptable by the Program Director or GIP administration will be removed from the experience. Participants are required to be aware of and observe the laws of countries visited during the immersion experience. The GIP is a credit-bearing course sanctioned by the Wharton School and the University of Pennsylvania; as such participants are subject to and accountable for upholding Wharton and Penn policies regardless of physical location. The integrity of the course will be enforced by Program Directors. Violations of this integrity do damage to the Wharton brand and will not be tolerated. Attention should be paid to the stresses associated with balancing the demands of the individual and the needs of the group. Participants are expected to listen to and follow the direction of program staff throughout the immersion experience, especially in circumstances impacting the safety of the group or an individual. Participants who have concerns about the conduct of the staff or their classmates should notify Program Coordinators, Directors, GIP Administration, or the MBA Program Office. Consequences for Failing to Abide by the GIP Code of Conduct The Wharton School, through its authorized representatives, reserves the right to expel from the GIP any participant whose conduct is detrimental to the group or the good name of the Wharton School. Any cancellation fees or additional costs an individual incurs as a result of having been expelled from the program are at the expense of the student. No refunds or program fee reductions will be made and the student will fail the course. ACKNOWLEDGMENT OF RISKS AND RELEASE FROM LIABILITY After carefully reading the statement below, please print and sign your name and note the date. I am a student in the Wharton MBA Program and will be participating in the India Global Immersion Program from December 28 through January 10, 2015 in the following locations for the expected dates: Jakarta – December 28 – December 30 Bali – December 30 – January 2 Kuala Lumpur – January 2 – January 7 Singapore – January 7 – January 10 In consideration for being allowed to participate in this seminar, I acknowledge and agree as follows: I understand that, although the Wharton MBA Program and the University of Pennsylvania have taken reasonable steps to provide appropriate resources and guidance for participants in this program, there are unavoidable risks associated with participation, including the risks associated with international travel. I confirm that I have been advised to consult the U.S. Department of State resources for information regarding travel to the country in which the program will be held and that I have had the opportunity to review any warnings or advisories regarding travel to each country. Please see http://travel.state.gov/ as well as the country specific information as follows: Indonesia http://indonesia.usembassy.gov/ Malaysia http://malaysia.usembassy.gov/ Singapore http://singapore.usembassy.gov/ By my signature below, I acknowledge that my participation in the Global Immersion Program 2014 may expose me to significant risks, including, but not limited to: crime, terrorism, war, and the hazards of travel by airplane, vehicle and foot, serious bodily injury or death, property damage and other risks that may not be foreseeable. I recognize that the Wharton MBA Program and the University cannot guarantee my safety or that of others traveling with me and that I am solely responsible for my safety. I also understand that the Wharton MBA Program and the University accept no responsibility for delays, loss or injury caused to others or me prior to departure, during travel or while abroad. Further, I agree that the Wharton MBA Program and the University shall not be responsible to any person for any acts or omissions on my part. I assume full responsibility for all risks associated with my participation (including risks to others who voluntarily travel to visit me) in the Global Immersion Program 2014 and I agree to release and hold harmless the Trustees of the University of Pennsylvania, and all of its schools and programs (including the Wharton MBA Program) and their respective trustees, officers, employees and agents from any claims, demands, causes of action or liabilities of whatever kind that I may have, including, but not limited to, illness, bodily injury, imprisonment, death and loss of personal property, resulting from or in any way connected with my travel to and from the Middle East or my participation in the program. Further, I understand that medical coverage provided by U.S. providers does not necessarily extend to overseas locations and it may be necessary for me to supplement my coverage. I agree that the University is not responsible for obtaining any health, accident, disability, or repatriation insurance that may be appropriate or required. I also agree that to the extent not covered by my insurance, I am responsible for all charges associated with any medical or emergency treatment I might have during the trip. I understand that, although the Wharton MBA Program will attempt to maintain the program as described in its publications and brochures, it reserves the right to change and/or cancel the program, including the itinerary, travel arrangements, or accommodations, at any time and for any reason, with or without notice, and the Wharton MBA Program and the University shall not be responsible or liable for any expenses or losses that I may sustain because of any such change or cancellation. I also understand that the Wharton MBA Program reserves the right to discontinue my participation in the seminar if my actions or behavior, in the sole discretion of the Wharton MBA Program, are determined to impede or obstruct the progress of the program in any way. I agree that, if there is any dispute concerning my participation in the seminar that would require adjudication by a court of law, then such adjudication will occur in the courts of and be governed by the laws of the Commonwealth of Pennsylvania. By signing below, I affirm that: I am at least 18 years of age; I have read and understand the terms of this Acknowledgement of Risks and Release from Liability; I am aware of my right to consult with an adviser or attorney of my choice regarding it; and I am signing it voluntarily and with the intent to be bound by it. Signature: _________________________________________________ Print name: Date: _________________ _______________________________________________________________________ PLEASE RETURN TO MBA Program Office 300 JMHH By Tuesday, September 30, 5:00pm 2014 SOUTHEAST ASIA – MGMT656:003 LOTTERY/REGISTRATION FORM I hereby confirm I have reviewed the MGMT656:003 Registration Packet in full, including the Timeline of Deliverables, GIP Standards and Procedures, Student Code of Conduct and Acknowledgement of Risks and Release from Liability. My signature below indicates my acknowledgement and agreement with the stated deliverables and terms of the Registration Packet, including but not limited to the Cancellation Policy, Code of Conduct and Risks and Release from Liability form. By submitting this form, I accept that if I win a seat in the course lottery, I will automatically be enrolled in the course and held financially responsible for 50% of the program fee, as explained in the Registration Packet. I understand this portion of the fee is nonrefundable. I understand that in order to be registered for this course, I must have Mondays, 4:30-6:30pm in quarter 2 available in my schedule. I understand that if I have a time conflict with my course schedule, I will be ineligible to participate in the GIP, and therefore I will be removed from the GIP lottery for this program. ________________________________________ ____________________________________ Signature Date ________________________________________ ____________________________________ Printed Name (as it appears on my passport) Phone ________________________________________ ____________________________________ Preferred Name (Nickname) Student ID Number If you would like to participate in the lottery for more than one program this semester, please circle your preference for this program in the event that you win both. Note, if you would like to be considered for both programs, you must submit forms for both programs and you will not be able to weigh your options after the lottery has concluded: 1st Choice 2nd Choice 3rd Choice N/A THIS FORM AND THE ACKNOWLEDGEMENT OF RISKS AND RELEASE ARE DUE IN 300 JMHH BY 5:00PM ON TUESDAY, SEPTEMBER 30 IN ORDER TO BE A PART OF THE LOTTERY For Office Use Only: Date/Time Received _________________________ By: ____________________
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