Education Abroad Registration

Overseas Program Student Agreement and Acceptance Offer This form must be completed if you are going overseas on an RMIT approved activity (for credit or not for credit). This caninclude but is not limited to:- Exchange- RIIERP- Study Tour- Short-Term Program- Internships- Field Work, Clinical placements

This form is for ALL RMIT students including VET, Higher Education and Higher Degrees by Research students. Where the program is NOT a full-semester or year long exchange program this form is also an application for the StudentMobility Grant. Exchange students apply for mobility via the exchange application. This form is required to access the OS-Help loans. Through this form you can also register your travel insurance details with the Education Abroad Office. This is arequirement of your overseas program. If you don't have your insurance details now you can complete this later separatelyvia the travel insurance site. Please read all instructions carefully.

No, I have never completed this formYes, I have completed this form and just need to enter travel insurance details

Have you already completed this form and just need to register your TRAVEL INSURANCE DETAILS?

Select your program type

ExchangeRIIERPStudy TourShort Term ProgramInternship (other than RIIERP)Other (field work, clinical placement etc.)

What program are you accepting your place in?

Congratulations! Youre about to head overseas and add to your Global Passport. Youll learn with and from people from many differentbackgrounds and cultures, experience the excitement and challenge of seeing the world through different eyes; and spendpart of your education immersed in a place that you dont call home. To formally accept you place in the RMIT University Outbound Mobility Program, please carefully read the following termsand conditions.

Pre-Trip Questionnaire Some light stuff before we get into the hard questions.

Where did you hear about RMIT Education Abroad programs? Check all that apply

Education Abroad Information Session FriendEducation Abroad Facebook Page RMIT academic

Education Abroad Website Website (external to RMIT) - please enter website

RMIT CareerHub Other - please describe RMIT University Facebook page

Canada Day - May 15, 2014Asia Week - July 28 - August 1, 2014Mexico Day - September 2014Bastille Day - July 2014Oktoberfest - Sept-Oct 2014

Have you attended any of the following events?

Friends recommendationRMIT academic adviceFamily suggestionEAO information sessionProgram locationProgram reputationProgram match with my RMIT programOther:

What MOST influenced your decision to participate in an overseas program?

What influenced your decision to chose your destination LOCATION? Not important Some impact Very important

Language of program(English)

Language of program(Language other thanEnglish)

Country's national language(English)

Country's national language(Language other thanEnglish)

Friends recommendation RMIT academic advice Family suggestion Program reputation Program match with myRMIT program

Program length Host country Health andSafety

Distance from Australia EAO information session Other:

What influenced your decision to chose your mobility PROGRAM? Not important Some impact Very important

Program location Program reputation Program match with myRMIT program

Program length Friends recommendation RMIT academic advice Family suggestion EAO information session Other:

Why did you choose to participate in an overseas program?I.e. Academic / experience / to meet new people / new culture etc. Please explain.

Academic

What are you most excited about?

Learning

What do you hope to gain from the experience?

Increased Self-Confidence Increased IndependenceNetworking/Collaboration Opportunities Increase career prospectsIncreased Language Proficiency Other: Increased Cultural Sensitivity

YesNo

Global Mobility PromotionWe want to get the word out about international education. The best ambassadors are the people that know! Wed love it ifyou could assist in the promotion and activities of the Education Abroad Office and/or your School. Activities could includetalking at student events, writing articles and blog posts, promotion through social media etc. Interested?

YesNo

Student Mentor Program Its a tough world out there and it makes it much easier for students going on a mobility program to talk to other studentswho have gone on a mobility program. Would you be happy for use to pass on your contact information to other studentswho have questions about their program?

First name (as it appears on passport)

Kei Jin

Surname (as it appears on passport)

Pook

Student Email

s3464569@student.rmit.edu.au

Date of Birthformat: dd/mm/yyyy

01/02/1991

YesNo

Using your photos or words Did you know that if you submit photos to us or provide testimonials about what a great time you had we can use this for thepurposes of promotion? Are you ok with that?

Personal Details

MaleFemale

Gender

School

Architecture and Design

ProgramProgram Code (for example: BP222)

MC163

Program Name(for example: Bachelor of Communication (Professional Communication)

Masters of Architecture

Program Level

PGRD

YesNo

Are you an Australian Citizen or Permanent Resident?

YesNo

Are studying at RMIT on an International Student Visa?

Country of Citizenship

Malaysia

Yes

Notification for International StudentsI understand that as an international student if I will be absent from Australia for more than 28 days, I must obtain a letterfrom the RMIT University Education Abroad Office to confirm my participation in the overseas program. It is then myresponsibility to notify the Department of Immigration and Citizenship (DIAC) at least 28 days prior to my departure.

Name of the Study TourRefer to the education abroad website and list the name of the study tour.

Designing Resilience in Asia 2015 International Design Competition, Symposium

RMIT Study Tour Coordinator or RMIT Program Coordinator/ManagerThis must be an RMIT staff member

Lindsay Holland

RMIT Study Tour Coordinator or RMIT Program Coordinator/Manager Email addressThis must be an RMIT email address

lindsay.holland@rmit.edu.au

Destination City

Singapore

Program Start Dateformat: dd/mm/yyyy

29/06/2015

Program End Dateformat: dd/mm/yyyy

30/06/2015

Overseas Program Information

Destination Country Where there is more than one select the country where you will spend the most time

Singapore

Enrollment Declaration

Yes

I understand that it is my responsibility to ensure that I am correctly enrolled at RMIT, and overseas if applicable, for theduration of my Program.

I also understand that it is my responsibility to ensure this enrolment is correct by the census date of each semester of theprogram I participate in.

I agree to consult my Academic Program Director before departure to ensure that I am correctly enrolled for the duration ofmy program.

Yes

I understand that I am required to undertake all study, training, fieldwork and tasks of the Program as outlined by my Schooland that failure to do so may affect my credit transfer.

Program Conditions

Yes

Unforeseen events I understand that RMIT University reserves the right to change or, if necessary, under exceptional circumstances terminatea students Outbound Mobility Program, if in its view continuance of the particular program would place in jeopardy either theUniversitys reputation, the safety and wellbeing of the student, or continued good relations with the partner institutions.

YesNo

Student Mobility Grant Are you applying for an RMIT Student Mobility Grant? Please read terms and conditions here. Note that applications CLOSE one the first day of the month prior to the study tour.For example: if your study tour starts in March you need to apply by Feb 1.

I understand that my personal and bank details may be made to the RMIT Payroll area to facilitate payment ofthe RMIT Student Mobility Grant.I certify that I understand the conditions by which my application will be assessed and understood theconditions by which RMIT Student Mobility Grants are awarded.I have included my 'academic history - course list' electronic copy (available from myrmit) with thisapplication.I acknowledge I have not received any other funding from RMITs Education Abroad Office (this does notinclude OS HELP).I acknowledge that if I am completing an internship I am only eligible for the Student Mobility Grant if theinternship is UNPAID

Student Mobility Grant Applicant declaration

Upload academic history course list

Academic history.docx10.4KB

application/vnd.openxmlformats-officedocument.wordprocessingml.document

University Funds and Scholarships

YesNo

Are you applying for OS-Help?This is NOT an application for OS-Help. It just states your intention - please refer to the RMIT OS-Help site for details onhow to apply.

Yes

I understand that RMIT is not obliged to provide any funds to assist with the payment of any of the expenses referred to inthis document unless it has agreed to do so in a signed letter addressed to me.

Yes

I understand that should I choose to withdraw from the program, I will have to return any RMIT grant or scholarship fundingawarded to me, except in exceptional circumstances. The Assistant Director, International Relations will assess whatcircumstances may be deemed exceptional.

Repayment of the grants or scholarships administered by the RMIT University Education Abroad Office is required if:

The proposed travel for this program is cancelled, not completed, or if the student fails to meet the terms andconditions of the specific program.For Semester Exchange, Semester Study Abroad, Short Term Programs/Study Tours, Clinical Placements, andInternships, failure to achieve a satisfactory result, as determined by the RMIT University Education Abroad Officeand RMIT University School.

Student Responsibility

Yes

Disclosure of personal information

I consent to the disclosure by RMIT of any personal information about me, including my academic record, in any or all of thefollowing circumstances:

If it facilitates the provision of my overseas program my details may be provided to the host institution or relevanthosting organisation;If RMIT believes the disclosure would assist any hospital or other medical provider;If RMIT believes the disclosure would assist in satisfying my immigration or visa requirements during the Program orotherwise facilitate my travel;If RMIT believes the disclosure is required to enable or assist me to obtain other funds; andI acknowledge that RMIT may be required to disclose my personal enrollment and academic details in certaincircumstances.

Yes

Program Withdrawal I understand that should I choose to withdraw from the program, I will have to inform the RMIT University Education AbroadOffice in writing of my intention to withdraw from the program as soon as possible. I understand that there may be fees associated with withdrawal after a certain date.

Yes

Maintaining contact I understand that I will need to check my RMIT email account regularly before and during my program as this is the primaryform of communication between RMIT University and myself.

Yes

Expenses: I agree to pay all expenses associated with my overseas program including but not limited to: All travel, visa, study,accommodation, living expenses, tuition/course fees and any cost resulting from the modification or termination of my tour.

Commonwealth Supported Places (CSP) or Full Fees (local students) or Tuition fees (International students);The cost of text books and educational supplies required for the Program;All travel, visa, accommodation and living expenses associated with my participation in the Program;All health insurance costs and medical and pharmaceutical expenses incurred for my benefit; andAll costs resulting from the modification or termination of my participation in the Program

Yes

Emergency Contact Information I am aware that I am responsible for updating my emergency contact information in myrmit.edu.au. This contact will beutilised in an emergency situation.

I agree

Indemnity I agree that I will indemnify the University from and against any liability, loss, harm, damage, cost or expense (includinglegal fees) that the University may suffer, incur or sustain as a result of my conduct during my participation, except to theextent that such liability, loss, harm, damage, cost or expense arises from the negligent or unlawful act or omission of theUniversity.

Yes

Additional Terms (specific to an individual overseas program) I understand any information provided to me regarding accommodation, or other service providers related to this overseasProgram, is not a recommendation or referral and I am not obligated to accept them.

I confirm that I am proceeding with the arrangements to undertake my Study Tour/Placement/Fieldwork/Internship of my ownfree will, and subject to the above conditions.

Before I leave Australia

I agree

Pre-departure briefingI acknowledge that I have been requested to attend and participate in a Pre-departure briefing conducted by my School, theRMIT University Education Abroad Office or available online, and that I have received a copy of the Education AbroadOffice Pre-departure Handbook and have noted the terms of the advice that it contains.

If you have already attended the Pre-departure briefing click "I Agree" belowIf you have not already attended the Pre-departure briefing you agree by clicking "I Agree" that you will contact the RMITUniversity Education Abroad Office in order to be updated with the information you missed.

I agree

Passport I agree to obtain a passport prior to my departure, or ensure my current passport is valid for the duration of the program plussix months.

I agree

Visas I understand that I am responsible for obtaining the appropriate visa or entry documents prior to my departure. The RMITUniversity Education Abroad Office will not dispense visa advice and I must contact the relevant consulate or embassydirectly.

I agree to purchase travel insurance, register my insurance details 10 days prior to departure, and complete aMy Trips Profile.I already have travel insurance and need to register with EAO and complete a My Trips Profile.

Health & Travel Insurance and Medical Pre-departure check I agree that I am responsible for obtaining insurance that will provide me with medical and health coverage for the duration ofmy participation in the Program, and that I am responsible for my own travel insurance. This is exclusive of any travel andhealth requirements set by the Host Institution. I also accept responsibility for receiving all the necessary vaccinations recommended or required for entry into my hostcountry. Additionally I acknowledge the recommendation that I seek the advice and a medical check-up from my doctor priorto my departure overseas. I agree to register my travel insurance details with the RMIT University Education Abroad Office and complete a My TripsProfile more than 10 days prior to travel. I agree to keep the My Trips profile up-to-date if and when my travel itinerarychanges

I agree

International SOS

I understand that RMIT partners with International SOS, a leading medical assistance, and international healthcare andsecurity assistance company. I can access an iSOS membership card and other relevant travel information via the TravelAdvice section of the Education Abroad (Outbound students) webpage.

Returning to Australia

Yes

I understand that I must submit a Student Feedback Form to the RMIT University Education Abroad Office within 3 monthsof the completion of my program.

Conduct Guidelines

I will be acting as an ambassador of RMIT throughout the program. I will conduct myself in accordance tolaws and cultural norms of the country I will be visiting. This means I will behave in a manner that will notcompromise my or RMIT's reputation.I agree that RMIT University may terminate my participation in the program if I fail to maintain what RMITUniversity considers to be an acceptable standard of public and private conduct, as per RMIT UniversityStatute 6.1 Student Discipline.I will Inform the group/buddy/mate/colleague of my individual movements and whereabouts, therefore placingme and my group's safety first.I will not buy or accept illicit drugs from anyone.I will respect cultural, university and community guidelines, and spiritual differences in the host countryI will respect the confidentiality, privacy and personal requirements of individuals in the host country and studytour group members.If in doubt, I will contact my host university, the Education Abroad Office, RMIT staff in my School or aniSOS representative for assistance.

I acknowledge and understand that:

I,

Kei Jin Pook wish to participate in the international program to Singapore from 29/06/2015 to 30/06/2015.

Form feedback RMIT Education Abroad are constantly striving to improve your experience in preparing for, going on and returning from youroverseas program.

We value your feedback!

If you have any feedback or comments regarding this form please feel free to leave them here.

Acceptance of the Offer The undertakings contained in this program Agreement and Acceptance of Offer Form shall become effective from the dateof submission and shall remain in effect for the duration of the program (including any authorised program extension).

I hereby declare that the information provided on this application is correct and complete.I authorise RMIT University to obtain official student records from the relevant institute/organisation to makean informed decision about my application or matters relating to enrolment.In an emergency I hereby grant RMIT University staff the authority to contact the nominated emergencycontact on my behalf.

Declaration

Program Coordinator/Manager Approval *Please read - important instructions After you click 'next' you will be taken to a response summary page.

Please follow these steps:Download application as a PDFSend via email to the email address listed below

Include the following text instructions *******************************************Dear [insert name]

I have just accepted a place in the [insert name of program] and have completed the overseas program agreement form.This requires your approval before it can be finalised and I can be considered for a student mobility grant and OS-Help (ifapplicable).

Can you please:Review the attached formForward my email with the form to eao@rmit.edu.au with the following text:

*******************************************

I approve [insert student name] as a participant of the program detailed in the attached form. I confirm that RMITrecognises this activity is full time and directly related to the students RMIT academic program (for credit or not for credit).

Regards

******************************************Don't forget to submit the form to complete the process (if you don't receive a message - THANK YOU FORCOMPLETING THIS FORM - your form HAS NOT been submitted correctly

lindsay.holland@rmit.edu.au

Have you already completed this form and just need to register your TRAVEL INSURANCE DETAILS?What program are you accepting your place in?Where did you hear about RMIT Education Abroad programs? Check all that applyHave you attended any of the following events?What MOST influenced your decision to participate in an overseas program?What influenced your decision to chose your destination LOCATION?What influenced your decision to chose your mobility PROGRAM?What do you hope to gain from the experience?Why did you choose to participate in an overseas program? I.e. Academic / experience / to meet new people / new culture etc. Please explain.What are you most excited about?Global MobilityPromotion We want to get the word out about international education. The best ambassadors are the people that know! Wed love it if you could assist in the promotion and activities of the Education Abroad Office and/or your School. Activities could include talking at student events, writing articles and blog posts, promotion through social media etc. Interested?Student Mentor Program Its a tough world out there and it makes it much easier for students going on a mobility program to talk to other students who have gone on a mobility program. Would you be happy for use to pass on your contact information to other students who have questions about their program?Using your photos or words Did you know that if you submit photos to us or provide testimonials about what a great time you had we can use this for the purposes of promotion? Are you ok with that?First name (as it appears on passport)Surname (as it appears on passport)Student EmailDate of Birth format: dd/mm/yyyyGenderSchoolProgram Program Code (for example: BP222)Program Name (for example: Bachelor of Communication (Professional Communication)Program LevelAre you an Australian Citizen or Permanent Resident?Are studying at RMIT on an International Student Visa?Country of CitizenshipNotification for International Students I understand that as an international student if I will be absent from Australia for more than 28 days, I must obtain a letter from the RMIT University Education Abroad Office to confirm my participation in the overseas program. It is then my responsibility to notify the Department of Immigration and Citizenship (DIAC) at least 28 days prior to my departure.Name of the Study Tour Refer to the education abroad website and list the name of the study tour.RMIT Study Tour Coordinator or RMIT Program Coordinator/Manager This must be an RMIT staff memberRMIT Study Tour Coordinator or RMIT Program Coordinator/Manager Email address This must be an RMIT email addressDestination CityDestination Country Where there is more than one select the country where you will spend the most timeProgram Start Date format: dd/mm/yyyyProgram End Date format: dd/mm/yyyyI understand that it is my responsibility to ensure that I am correctly enrolled at RMIT, and overseas if applicable, for the duration of myProgram. I also understand that it is my responsibility to ensure this enrolment is correct by the census date of each semester of the program I participate in. I agree to consult my Academic Program Director before departure to ensure that I am correctly enrolled for the duration of my program.I understand that I am required to undertake all study, training, fieldwork and tasks of the Program as outlined by my School and that failure to do so may affect my credit transfer.Unforeseen events I understand that RMIT University reserves the right to change or, if necessary, under exceptional circumstances terminate a students Outbound Mobility Program, if in its view continuance of the particular program would place in jeopardy either the Universitys reputation, the safety and wellbeing of the student, or continued good relations with the partner institutions.Student Mobility Grant Are you applying for an RMIT Student Mobility Grant? Please read terms and conditions here. Note that applications CLOSE one the first day of the month prior to the study tour. For example: if your study tour starts in March you need to apply by Feb 1.Student Mobility Grant Applicant declarationUpload academic history course listAre you applying for OS-Help? This is NOT an application for OS-Help. It just states your intention - please refer to theRMIT OS-Help sitefor details on how to apply.I understand that RMIT is not obliged to provide any funds to assist with the payment of any of theexpenses referred to in this document unless it has agreed to do so in a signedletter addressed to me.I understand that should I choose to withdraw from the program, I will have to return any RMIT grant or scholarship funding awarded to me, except in exceptional circumstances. The Assistant Director, International Relations will assess what circumstances may be deemed exceptional. Repayment of the grants or scholarships administered by the RMIT University Education Abroad Office is required if: The proposed travel for this program is cancelled, not completed, or if the student fails to meet the terms and conditions of the specific program. For Semester Exchange, Semester Study Abroad, Short Term Programs/Study Tours, Clinical Placements, and Internships, failure to achieve a satisfactory result, as determined by the RMIT University Education Abroad Office and RMIT University School.Disclosure of personal information I consent to the disclosure by RMIT of any personal information about me, including my academic record, in any or all of the following circumstances: If it facilitates the provision of my overseas program my details may be provided to the host institution or relevant hosting organisation; If RMIT believes the disclosure would assist any hospital or other medical provider; If RMIT believes the disclosure would assist in satisfying my immigration or visa requirements during the Program or otherwisefacilitate my travel; If RMIT believes the disclosure is required to enable or assist me to obtain other funds; and I acknowledge that RMIT may be required to disclose my personal enrollment and academic details in certain circumstances.Program Withdrawal I understand that should I choose to withdraw from the program, I will have to inform the RMIT University Education Abroad Office in writing of my intention to withdraw from the program as soon as possible. I understand that there may be fees associated with withdrawal after a certain date.Maintaining contact I understand that I will need to check my RMIT email account regularly before and during my program as this is the primary form of communication between RMIT University and myself.Expenses: I agree to pay all expenses associated with my overseas program including but not limited to: All travel, visa, study, accommodation, living expenses, tuition/course fees and any cost resulting from the modification or termination of my tour. Commonwealth Supported Places (CSP) or Full Fees (local students) or Tuition fees (Internationalstudents); The cost of text books and educational supplies required for the Program; All travel, visa, accommodation and living expenses associated with my participation in theProgram; All health insurance costs and medical and pharmaceutical expenses incurred for my benefit; and All costs resulting from the modification or termination of my participation in the ProgramEmergency Contact Information I am aware that I am responsible for updating my emergency contact information in myrmit.edu.au. This contact will be utilised in an emergency situation.Indemnity I agree that I will indemnify the University from and against any liability, loss, harm, damage, cost or expense (including legal fees) that the University may suffer, incur or sustain as a result of my conduct during my participation, except to the extent that such liability, loss, harm, damage, cost or expense arises from the negligent or unlawful act or omission of the University.Additional Terms (specific to an individual overseas program) I understand any information provided to me regarding accommodation, or other service providers related to this overseas Program, is not a recommendation or referral and I am not obligated to accept them. I confirm that I am proceeding with the arrangements to undertake my Study Tour/Placement/Fieldwork/Internship of my own free will, and subject to the above conditions.Pre-departure briefing I acknowledge that I have been requested to attend and participate in a Pre-departure briefing conducted by my School, the RMIT University Education Abroad Office or available online, and that I have received a copy of the Education Abroad Office Pre-departure Handbook and have noted the terms of the advice that it contains. If you have already attended the Pre-departure briefing click "I Agree" below If you have not already attended the Pre-departure briefing you agree by clicking "I Agree" that you will contact the RMIT University Education Abroad Office in order to be updated with the information you missed.Passport I agree to obtain a passport prior to my departure, or ensure my current passport is valid for the duration of the program plus six months.Visas I understand that I am responsible for obtaining the appropriate visa or entry documents prior to my departure. The RMIT University Education Abroad Office will not dispense visa advice and I must contact the relevant consulate or embassy directly.Health & Travel Insurance and Medical Pre-departure check I agree that I am responsible for obtaining insurance that will provide me with medical and health coveragefor the duration of my participation in the Program, and that I am responsible for my own travel insurance. This is exclusive of any travel and health requirements set by the Host Institution. I also accept responsibility for receiving all the necessary vaccinations recommended or required forentry into my host country. Additionally I acknowledge the recommendation that I seek the advice and amedical check-up from my doctor prior to my departure overseas. I agree toregister my travel insurance details with the RMIT University Education Abroad Office and complete a My Trips Profilemore than 10 days prior to travel. I agree to keep the My Trips profileup-to-date if and when my travel itinerary changesInternational SOS I understand that RMIT partners with International SOS, a leading medical assistance, and international healthcare and security assistance company.I can access an iSOS membership card and other relevant travel information via the Travel Advice section of the Education Abroad (Outbound students) webpage.I understand that I must submit aStudent Feedback Formto the RMIT University Education Abroad Office within 3 months of the completion of my program.I acknowledge and understand that:I,DeclarationForm feedback RMIT Education Abroad are constantly striving to improve your experience in preparing for, going on and returning from your overseas program. We value your feedback! If you have any feedback or comments regarding this form please feel free to leave them here.Program Coordinator/Manager Approval *Please read - important instructions After you click 'next' you will be taken to a response summary page. Please follow these steps: Download application as a PDF Send via email to the email address listed below Include the following text instructions ******************************************* Dear [insert name] I have just accepted a place in the [insert name of program] and have completed the overseas program agreement form. This requires your approval before it can be finalised and I can be considered for a student mobility grant and OS-Help (if applicable). Can you please: Review the attached form Forward my email with the form to eao@rmit.edu.au with the following text: ******************************************* I approve [insert student name] as a participant of the program detailed in the attached form. I confirm that RMIT recognises this activity is full time anddirectly related to the students RMIT academic program (for credit or not for credit). Regards ****************************************** Don't forget to submit the form to complete the process (if you don't receive a message - THANK YOU FOR COMPLETING THIS FORM - your form HAS NOT been submitted correctly