COCC STUDY ABROAD PROTOCOL NARRATIVE
(to accompany program application)
For employees proposing a study abroad program in conjunction with COCC and OSU-Cascades partner(s), and/or an outside contractor, the following outlines steps for submitting a proposal and creating finalized agreements. This process should begin well in advance of the term the trip is proposed – at least three terms prior to the term of the program is required to obtain necessary authorizations and provide for budgetary planning. Abroad programs follow the “break-even” rule.
Questions about the proposal or the process should be directed to Celeste Brody, Instructional Dean or Eleanor Sumpter-Latham, Director of Summer Sessions.
1. Program Plan
The faculty/staff who propose a study abroad program (herein referred to as a program) include a proposal with the following information:
A. Name of the Program Director and/or designees of the Program Director. Include complete contact information.
B. Learning goals of the program.
C. Courses proposed, credits, and course titles.
D. If instructors are not COCC faculty they must be approved by the department that oversees the proposed course and complete the necessary COCC paperwork in order to be hired by COCC.
E. Beginning and ending dates (proposed) for the program and term in which the program is to occur. Be as specific as possible.
F. If this is to be a joint proposal with UO or OSU, indicate who will be involved and in what capacity.
G. Indicate who will review applications, conduct interviews, issue acceptance letters and collect payments.
2. Budget
A. Indicate whether COCC is to act as fiscal agent for the program, that is, whether COCC is expected to collect tuition and fees or whether outside contractor will collect fees and other costs.
B. Include cost of instruction, i.e., how the instructors are to be paid e.g., through contract services or as part-time instructors, on-load, and anything the instructor expects for expenses. Include number of students (minimum and maximum). For summer programs, factor in fringe benefits and other expenses for the program.
C. If this is a program between COCC and Cascades Campus partners, indicate who will prepare and distribute campus-specific promotional materials and how they will participate in the financial arrangements.
In no case shall it be assumed that the College can provide support services for the program. All programs are to operate on a cost recovery basis.
Normally, 10% of budget will be delineated for COCC administrative overhead. If the College pays only for the cost of instruction (i.e., collects tuition and pays salary through an NOA), the budget must cover the full costs of salary, fringe benefits as well as 10%.
If the College contracts with an outside provider who will collect fees and pay instructional costs, COCC will negotiate with this provider in such a way that COCC will recover its costs (e.g., collecting the student tuition and retaining a small portion thereof), using the 10% budget formula.
When COCC faculty propose a program, they will factor in their time for planning, marketing and recruiting applicants. If they propose otherwise, the proposal should indicate how these tasks will be accomplished and paid for.
Once a proposal is submitted as per 5 below, they are subject to negotiation and will result in a statement of agreement, or contract (in the case of an outside contractor) with the parties involved.
3. Student Application Process
The program plan will include the deadline date of submission of the student application to the Program Director or designee. The application process should occur before the date due of the non-refundable deposit. The application should indicate a date after which applications will not be accepted. The application process includes:
A. Completion of an application that includes a general release as per the following (See Application Disclosure to be attached to application)
:
· Student responsibility for payment of all program costs
· Refund or cancellation policy and deadlines
· Statement about student conduct while participating in the program
· Police record statement.
· Prohibition of use or possession of illegal drugs during the duration of the program
· Responsibility for requesting reasonable accommodations related to a documented disability
· Requirements to make known medical and psychological needs in a timely manner
· Responsibilities surrounding independent travel during free time
· Risks and dangers of travel
· Requirement to hold a valid passport
· Requirement to provide proof of medical insurance and/or purchase student medical insurance including medivac insurance (if more than one hour from a hospital or emergency clinic)
· A statement about conditions under which the program could be terminated due to internal and international safety standards
· A statement about terminating a student’s program and sending him/her home or out of the program. Include factors such as those listed above and any others (failure to register for the courses by the time of departure, and deadlines for determination (if applicable).
B. A non refundable deposit (eg., $100) designated payable to COCC and/or outside contractor.
C. Completion of an interview by the Program Director or designee.
D. Proof of good academic standing, i.e., no academic warnings at the time of application.
E. Request for reasonable accommodations related to a documented disability in a reasonable time frame prior to departure.
F. Application forms must state that the Program Director has the authority to accept or deny a student on the basis of any of the above information.
G. Completion of a medical history/health form (See Medical History/Health Form)
4. Safety and Risk Management Plan
Before a final contract is signed between COCC an outside contractor and/or approved internally between COCC administration and staff, the Program Director must develop a Safety and Risk Management Plan. The plan is due at the time of the submission of the proposal.
A. The plan must include a written supervisory outline showing an adequate number of staff and qualifications these staff in the program as these relate to the standard of care for the activity. For example, on wilderness trips outside of the country, there should be two faculty/staff for 8 hikers. Trips to urban areas only may use a different ratio of faculty/staff to student, but no less than one staff person for 10 students. Explain the student to faculty/staff ratio for the trip and what will happen to the group if a faculty/staff has to accompany a sick or injured student to a health facility (or out of the wilderness/country).
B. The plan includes the student application with the completion of the medical history/health form and a disclosure form
C. Students will also sign a COCC Student Waiver and Acknowledgement of Risk before they leave the U.S. for the Study Abroad Program. Copies of both forms must be held with the Risk/Liability Office at the College.
D. Students must purchase the ISIC student ID card that provides insurance for student travelers. They will purchase medivac insurance if the program involves a wilderness component. In the plan include the necessary immunizations students need to acquire before leaving. Faculty/staff shall inform students of the immunizations in the program material.
The contact for ISIC student health insurance is:
http://www.counciltravel.com/idcards/insure.asp
http://www.counciltravel.com/idcards/isic.asp
E. If the program is held in a third world country, the plan shall/must indicate where health care facilities are located, the transport time to these facilities, the standard of transport, and the ability of the Program Director or outside contractor to contact the U.S. embassy.
F. The Program Director shall acquire a list of doctors in the region able to deliver western and/or emergency medicine before the trip departs. If program will be held in wilderness areas,faculty/staff are to consult IAMAT. Information about this can be obtained from www.iamat.org, a medical service free to consumers, as well as www.cdc.gov/travel/reference.
G. The Program Director shall have a COCC contact to if there is an emergency. This contact will coordinate communication between the person and/or students’ emergency contact. If the student must be sent home, this contact will arrange to have someone meet the student. This person will normally be:
The instructional dean for Study Abroad or their designee.
H. In the case that the U.S. State Department issues a Code Red warning, to the effect that U.S. citizens must evacuate the region where the Study Abroad program is occurring, the COCC faculty/staff will terminate a program immediately. The COCC faculty/staff will inform the COCC designee as soon as he or she is able to do so. Staff are to consult regularly the following: www.travel.state.gov.
5. Release and Waiver Forms
The Program Director shall provide materials for students that indicate the following:
A. Deadlines for dropping courses before the trip departs and after the students are in the overseas location.
B. The Student Waiver & Acknowledgement of Risk may be one that has been designed by the college in conjunction with the Risk/Liability Office. If there is one developed by an outside contractor, it will be reviewed by the Risk/Liability Office. (See also Application Disclosure and Medical Release for students to sign at the time of application.)
C. If the Program Director is not available to COCC during the academic terms in which the planning and approval process is occurring, or will have the need for administrating requirements and conditions of the program during his/her absence overseas, the Program Director will name a manager or designee authorized to act in his/her absence. The person is subject to the same approval by the College as is the Program Director.
6. Date of Submission of the Program Plan and Budget:
The dates of submission and approval of the following information are determined by the dates for the printing of the class schedule that covers the program. E.g., summer term programs would be submitted to the oversight dean six weeks before schedule copy due date; regular term programs would be submitted three terms prior to the starting date of the program.
The plan will be signed off by:
A. Department chair(s) of faculty where courses are being taught or Director of Summer Sessions
B. The oversight dean for study abroad programs, and
C. The Risk/Liability Representative for the College.
7. Contractual Agreements with the College
If the program involves an outside contractor, the Program Director will work with the Risk/Liability Officer to create the terms of the contract of agreement based on the review of the proposal, including the safety/risk management plan. This contract will include:
A. The nature of professional services provided.
B. Payment for professional services.
C. Conditions.
An outside contractor will provide the necessary documentation as stipulated by the Risk/Liability Representative for the College. If the party is unable to provide the required documentation by the date indicated, the College may cancel the program.
Central Oregon Community College
Application Disclosure
Program Name:
I, the undersigned, wish to participate in the program sponsored by in coordination with COCC. I understand that:
- I am responsible for payment of all program fees and understand that if they are not paid before departure my participation in the program will be denied.
- I have a valid passport or have applied for a passport.
- I understand that request to cancel occurring after the enrollment deadline is based on recoverable costs, and that depending on the date of cancellation, program costs may be forfeited. No refund is given to students who wish to omit portions of the program. Notice of cancellation must be submitted in writing.
- I agree to purchase the ISIC card. This card is available on line and costs $20. (www.counciltravel.com/idcards/insure.asp) I am responsible for any additional insurance that I may elect.
- I am subject to the COCC Student Conduct Code while participating in this program, and all rules of conduct established. I understand that if I violate the student conduct code or the rules of conduct established by staff and faculty and the outside contractor, ¸ I may be denied further participation in the program.
- I hold no criminal record that would prevent me from leaving the United States to attend this program, or entering the country where this program is being held.
- I may not purchase, possess or use illegal or unauthorized drugs during the duration of the program, including free time. I understand that illegal drug purchase, possession, or use jeopardizes myself, other students in the program, and the program itself. I understand that neither the program nor the U.S. Embassy can obtain release from jail if I am jailed for any reason. I understand that violation of this rule of conduct may result in immediate expulsion from the program. I further understand that I would remain responsible for the full payment of all program fees.
- I accept the standard of responsible use of alcohol during this program; and prohibitions regarding alcohol use when indicated by the director.
- I will bring my own prescription drugs for medical conditions and will not purchase prescription-level drugs during the program.
- I am currently in good academic standing (no academic warnings) at COCC.
- I understand that if I have a physical or learning disability (recognized under Section 504 of the Rehabilitation Act) I may receive special assistance. If such need exists, it is my responsibility to provide documentation and to inform the College of this need in a timely manner. (Contact Disability Services, BEC X7580). I understand that if I fail to make my medical and psychological needs known in a timely manner, I may jeopardize my participation in the program.
- I understand that if I need to see a physician because I have answered “yes” to one of the conditions on the medical/health history form, and should there be an adverse medical opinion by my physician that I will not be allowed to participate in the program.
- I am responsible for informing an official representative of the Study Abroad Program of any plan to travel during free time before, during, and after the period of my program. I understand that neither COCC nor its staff, agents, or representatives are responsible for any non-program sponsored travel.
- I understand that there are unavoidable risks in travel abroad. I am aware of and understand the risks and danger to my own health and personal safety posed by the use of public transportation to and from and in my site country, by domestic or international terrorism, and by civil unrest, political instability, crime, violence and disease in my site country. I hereby assume, knowingly and voluntarily, each of these risks and all of the other risks that could arise out of or occur during my travel to, from, in, or around my site country.
- I, individually, and on behalf of my heirs, successors, assigns, and personal representatives, release Central Oregon Community College, its staff, agents, and representatives, from any and all liability whatsoever for damages, losses, or injuries (including death) that I may sustain to my person or property, arising out of, resulting from, or occurring during my participation in the program or any travel incident thereto, whether caused by negligence or carelessness of Central Oregon Community College, its staff, agents, or representatives, or otherwise. This release applies to any loss of property, injury, illness, or death due to theft or other crimes committed by persons other than the employee or agents of the Central Oregon Community College, political unrest, use of modes of transportation, and activities on the part of fellow participants, host family members, agencies, and organizations, persons, or groups with which the Central Oregon Community College contracts or which the Central Oregon Community College recommends for the provision of services for the program. This release further applies to any independent travel or optional activities or sojourns that I may undertake during the program. This release do not apply to intentional, willful, or wanton acts of the Central Oregon Community College, or its staff or agents.
I authorize the staff of to secure medical treatment on my behalf in the event of an emergency illness or injury, and I accept financial responsibility for such medical treatment.
I also authorize the staff of or COCC to release medical information contain in the COCC files to a care provider in the event of an emergency illness or injury, or as needed to provide reasonable accommodations.
I understand that this program could be cancelled by COCC and/or if conditions in the host country warrant, including, but not limited to the US State Department issuing a restriction on travel to this country or region, due to civil or international unrest that would compromise my safety. In such an event, COCC and/or will make reasonable effort to secure a refund or reschedule the program.
I have read and accept each of the above responsibilities and voluntarily sign this
Release and waiver.
Signature of Participant Date
Name (Please Print)
COCC STUDY ABROAD PROGRAM APPLICATION
(To accompany Protocol Narrative)
Date of Submission_____________________
I. Program Plan for:_____________________________________________
A.. COCC Director Name(s):______________________________
Outside Contractor (if applicable):
Local Contact Information:
Phone: FAX:
Mailing Address:
Email:
B. Learning goals of the program:
C. Courses proposed: (include course title, CRN and credit to be granted through program participation).
D. Instructors: (Instructors not currently COCC faculty must be approved by the department that oversees the proposed course and complete the necessary COCC paperwork in order to be hired. Attach vitas of proposed new instructors.)
E. Beginning date and term: Ending date and term:
F. OSU/Cascades partner? In what capacity?
G. Who will:
Review applications_________________ Conduct interviews__________________ Issue acceptance letters_____________________________
Collect payments____________________
2. Budget for___________________________________________________:
A. COCC will ( ) or will not ( ) act as fiscal agent for the program.
Expenses:
B. Cost of instruction: instructors salary, fringe benefits, and anything instructor expects for expenses.
Who will pay instructors? COCC?________ Outside Contractor?___________
How will instructor(s) be paid: contract services ( ) part-time instructor ( ) on-load ( )?
Explain
Cost of special insurance, if COCC is to provide it.
10% of proposed budget for COCC administrative overhead if COCC acts as the fiscal agent.
Other costs:
Revenue:
Tuition
Fees
Indicate number of students X tuition X fees to cover expenses, including overhead.
C. Joint programs: Who will cover costs of campus-specific promotional materials, etc.?
TOTAL Expenses: TOTAL Revenue
3. Student Application – attach separately. Include the following:
· Personal information
· Non-refundable deposit due (date)
· Proof of good academic standing
· Request for reasonable accommodations related to a documented disability
· Program director has authority to accept or deny a student on the basis of any of the above information
· Requirement to purchase medical insurance and (if applicable) medivac insurance
· Deadline for dropping courses before trip departs
· Program Waiver
· Medical History/health form
4. Safety and Risk Management Plan for ___________________________________
A. Outline kind of activities and the normal standard of care for the activity.
· Include anticipated number of students (maximum and minimum) and staff/student ratio.
· Define qualifications of staff for handling medical/safety emergencies.
· Plan for handling medical emergencies
B. Attach the medical history/health form (student application)
C. Attach the release and waiver form (student application)
D. Indicate on application the required health insurance and medivac insurance (if applicable).
· Indicate vaccinations for immunizations needed for program (or where to locate that information).
· Indicate that students be sure to hand carry copies of medical records, if there are special medical needs or requirements.
E. Do you or contractor know where emergency medical facilities are located? ___
Transport time to facility? ______
U.S. Embassy/Consular contact? ______
F. Obtain a list of medical personnel in region before contract is approved.______
G. COCC emergency contact will be:________________________________
COCC STUDY ABROAD MEDICAL HISTORY/ HEALTH FORM
NOTE: This form is essential for your safety and enjoyment of the trip. Please take the time to fill out completely and accurately; and return promptly. It is considered confidential and will only be available to necessary personnel. Upon completion of the program, this form will be destroyed.
Name Sex Date of Birth
Address
Home Phone ( ) Work Phone ( )
IN CASE OF EMERGENCY NOTIFY:
(1ST) Name Relationship
Home Phone ( ) Work Phone ( )
(2nd) Name Relationship
Home Phone ( ) Work Phone ( )
MEDICAL HISTORY: (please attach additional sheet if necessary)
· Allergies (check if yes): Insects (bees, etc.) Penicillin Aspirin
Other medication – please list types:
Food – please list types:
Other allergies – please list types:
If yes to any of the above, please describe your allergic reaction and how you treat it: (Serious health factors may require your physician’s sign-off).
· Are you on any medication? If yes, please list name(s) and what each is for:
· Do you have any sight or hearing problems? If yes, please describe:
· Do you use a corrective/supportive brace or devise? If yes, please describe:
· Are you a vegetarian or do you require a special diet? If yes, please describe:
· Do you have a history of (check if yes):
Frostbite – where Asthma Hypothermia
Poor circulation Back problems Abnormal/high blood pressure
Migraines Stomach problems Snow blindness
Knee or other joint problem Seizures Diabetes or low blood sugar
Dizziness Bronchitis Menstrual problems
Arthritis Past Surgery Fainting or heat exhaustion
HIV Problems with altitudes above 10,000 feet
If yes to any of the above, please describe your current situation and if you have been treated (you may need a physician’s release to participate):
· Is there anything else that we should know about you to ensure your health and safety and the safety of others? (phobias, sensitivities, needs, etc.?)
· I have answered all of the above questions accurately and completely. (initial)
· I am in good physical condition and can participate fully in this trip’s activities. (initial)
· In the event that you may require blood in an emergency situation, will you accept host country blood that may or may not be screened? (Yes or no, then initial) Blood Type
· The staff of COCC have permission to seek and/or administer emergency care for the participant in the event the participant or guardian cannot respond at the time of the emergency.
Signature Date
COCC STUDY ABROAD PROGRAM AUTHORIZATION
For Study Abroad Programs copies of the (1) Program Plan, (2) Budget, (3) Student application packet and (4) Safety/Risk Management Plan are to be submitted to both the oversight dean in charge of these programs and the director of summer sessions as per Section 6 of the Protocol Narrative. The plan will be reviewed and signed by the following:
NAME OF PROGRAM:___________________________________
1. Program Plan, Budget and Student Application:
A. If instructor(s) are new to COCC, the program plan and recommendations for instructors faculty meet the standards of COCC and require approval of department Chair(s):
________________________________ ___________________ ________________
Department Chair Department Date
________________________________ ___________________ ________________
Department Chair Department Date
B. The program plan, budget and student application are accepted (indicate any changes or conditions below).
__________________________________ ___________________
Instructional Dean Date
___________________________________ _____________________
Director of Summer Sessions Date
__________________________________ _____________________
2. The safety/risk management plan is accepted.
_________________________________ ______________________
Financial and Contract Analyst Date
_________________________________ _______________________
Physician Date