Summer Travel/Study Program in Italy Application/Registration - Maria C. Mansella - Faculty Web

Summer Travel Study Program in Italy

June 25-July 18, 2013

Application/Registration Form

Registration is on-going now. Please complete this form and submit it along with a $395.00 deposit by
March 15, 2013 as well all required documents to the address below. Make check or money order payable to
CCRI Program in Italy. Full program payment is due May 2, 2013. Please PRINT all information.

First Name: ____________________________ Middle Initial: _____ Last Name:_____________________________

CCRI ID*:______________________________ D.O.B. __________________________________________________

*Your CCRI ID# is the 8-digit number below your name on your CCRI ID. If you are not a CCRI student,
you will be assigned an ID Number after being admitted to the Summer Program in Italy.

Home Telephone: ____________________________________ E-mail:_______________________________________

Street Address____________________________________________________________________________________

City: ________________________________________________________State: ________ Zip Code: _____________

Have you studied Italian? __________________ If so, when?__________ Highest level courses taken: ____________

Institution attended: __________________________________ Concentration/Major____________________________

Special interest/needs______________________________________________________________________________

Why do you want to participate in this program?

_________________________________________________________________________________________________

Please indicate your preferences:

___ I am enrolling for credits

___ No credits/Audit

___ Double occupancy: ___ nonsmoker ____ smoker

___ Single room requested

___ 1 week program (June 25-July 04, 2013)

___ 2 week program (June 25-July 11, 2013)

___ 3 week program (June 25-July 18, 2013)

___ I am an accompanying participant

I am enrolling in:
(Participants may register for a total of 6 credits)

___ Elementary Italian I (ITAL-1030 -3 credits)

___ Conversational Italian I (ITAL -1510 -3 credits)

___ Italian Heritage (ITAL-1900 -3 credits)

___ Italian Culture-Cuisine (ITAL-1910 -1 credit)

___ Italian for Business & Travel (ITAL-8040 -1 credit)

___ Italian Course(s) not listed above

___________________________________________________________

___ Copy of Medical Insurance enclosed

___ Photocopy of the photo information page of passport enclosed

___ $395.00 Deposit enclosed

___ Release Form enclosed
(The release form will be sent to you upon acceptance in the program)

Please read carefully the following information:

The Summer Program in Italy requires extensive long-term planning and preparation.
We encourage participants to enroll as early as possible. Applications will be reviewed
in the order received. Notification of acceptance in the program will be communicated
by the Program Coordinator/Director.

► Final payment is due May 2, 2013. Please make a check payable to CCRI Program in Italy.
► The $395.00 deposit will be applied toward program fee.
► Students enrolled for 3 credits or more must attend the full 3-week program (June 25-July 18, 2013)
► Applicants may be interviewed in addition to completing the application.
► Participants must attend pre-departure informational meetings.
► Participants will be registered for their courses upon acceptance into the program.
► It is the participant's responsibility to pay his/her tuition directly to the CCRI Bursar's Office before
    departure.
► The CCRI Program in Italy reserves the right to cancel the program prior to departure for insufficient
     enrollment or other valid reasons. In the event of cancellation by CCRI, a full program refund will be
     provided.
► Participants are strongly recommended to purchase travel insurance when booking their flight.
► If a participant must withdraw from the program, a cancellation letter, sent via traditional mail, must be
     received.
The following Cancellation Policy applies. Charges are calculated as the day written
notification is received:

☺ 90 days before departure: no refund administrative study abroad fee $180.00.
☺ 60-90 days before departure: no refund $395.00 deposit and administrative fee.
☺ 30-60 days before departure: 25% program cost refund, less deposit and administrative fee.
☻30 days or less before departure, and after the starting of the program in Italy: no refund.

By signing below, you confirm your participation in the 2013 CCRI Summer Program in Italy.

Signature:____________________________________ Date:__________________________________

Please mail all required documents with a $395.00 deposit to:

Maria C. Mansella, Professor
Community College of Rhode Island
Department of Foreign Languages and Culture
400 East Ave. Warwick, RI 02886