APPLICATION AGREEMENTS, POLICIES AND WAIVERS

All students that have been accepted and confirmed to study away at the Trinity College Rome Campus have already agreed to or signed the below agreements, policies and waivers in your application pre and post-acceptance. 

Please be sure to review all of the items below.

STUDY AWAY ELIGIBILITY: Trinity College Rome Campus has a minimum requirement of a 3.0 cumulative GPA. To remain eligible, students must remain in good academic and social standing, fulfill the quantitative literacy requirement, and not incur academic probation and⁄or censure. Students must adhere to all study away deadlines as outlined on the website and through email communications from the OSA. Failure to do so may result in their study away approval being withdrawn. 

COMMITMENT TO STUDY AWAY: Trinity plans for enrollment, courses, and housing based upon the submitted applications. The college takes students' commitment to study away seriously. Once students have applied to their program and been accepted, they will then be placed on a Study Away List. This information is shared with departments on campus. The only way to be removed from this list is to contact your study away advisor in the OSA via email to advise them of your change of plans to withdraw from study away. 

FINANCIAL AID AND STUDY AWAY INFORMATION FOR TRINITY STUDENTS ONLY: If you receive Financial Aid please ensure you have read and understand the following information.

• Financial Aid Process for Study Away

• Study Away FAQ - Financial Aid

• Study Away Financial Planning

NEXT STEPS: Students who meet the eligibility requirements and have already met with the study away advisor for their program can continue to complete this application. Please initial here to acknowledge your understanding and acceptance of these terms.

All students studying at the Trinity Rome Campus are required to get an Italian study visa (EXCEPT students with valid passports issued by a country in the Schengen Area).

Students will begin working on their Italian Visa Application after they are accepted and confirmed to the program. The Trinity Rome Adviser will assist students through the visa application process. Do not start working on the visa application until you have been accepted to the Trinity Rome Campus and have received detailed visa instructions from the Trinity Rome adviser. 

IMPORTANT THINGS TO BE AWARE OF EARLY:

• Students will be without their passport for several weeks to  several months while their visa is being processed at the Italian Consulate. Students cannot travel internationally during this time.

• The Italian government requires students or their parents to provide detailed official documentation proving they have sufficient financial funds for the duration of the program. Bank statements, official bank letters, etc. will need to be submitted with your visa application. More information will be provided after the student has confirmed their spot on the program.

• It is recommended that students have at least $4,500-$5,500 in an individual checking account (no joint or savings accounts) at the time they apply for an Italian visa. This is just an estimate based on historical requirements. The required dollar amount changes regularly and may be different at each Italian Consulate. If providing the recommend financial information is not possible, the student will need to speak with the Trinity Rome adviser to discuss alternative options..

• International students must provide financial information from an American bank. Foreign bank records will not be accepted.

• Students may have to travel to an Italian Consulate in the US to submit their visa application in person.

• It is highly recommended that international students apply for their Italian visa in the United States and not their home country.

The Office of Study Away will share your name and intention to study away with various offices on campus. We encourage you to speak with the Deans Office about your student conduct record as you prepare for your time abroad in a new learning environment. Most study away programs require the College to share information with them regarding your academic and disciplinary standing. To do so, we need your permission to share this information. This Release gives permission to Trinity College to release your academic and conduct information as requested by any study abroad or domestic study program to which you apply. “Academic information” includes courses taken, grades received, GPA, academic progress, honors, and transfer credit awarded. “Conduct information” includes any information in your student conduct file or otherwise relating to any alleged or actual violation of the Student Code of Conduct. Most programs will not automatically disqualify you by virtue of having a conduct record and will provide you an opportunity to discuss your record. The above records are protected from disclosure under the Family Educational Rights and Privacy Act of 1974 and may be released only under certain conditions, including upon your authorization. 

Select “yes" if you give your permission to release this information. Select "no" if you do not give your permission to release this information.

The Office of Study Away will share your name, Trinity College email address, study away term, city(ies), country(ies), and the name of your confirmed study away program with other Trinity College students confirmed to study away during the same academic term. To foster a stronger Trinity College community while studying away, the Trinity College Office of Study Away would like study away students to know where other Trinity College study away students will be studying during the same academic term. This may provide more opportunity for community connections while abroad. To do so, we need your permission to share this information. 

This Release gives permission to Trinity College to release your name, Trinity College email address, study away term, city(ies), country(ies), and the name of your confirmed study away program with other Trinity College students confirmed to study away during the same academic term. The aforementioned information is protected from disclosure under the Family Educational Rights and Privacy Act of 1974 and may be released only under certain conditions, including upon your authorization.

Select “yes" if you give your permission to release this information. Select "no" if you do not give your permission to release this information.

Please Note: This is a required form. Submission of a signed copy of this form is required of all study abroad program applicants. By signing this form, students who participate in a Trinity program agree to act in accordance with the laws and customs of their host country and to abide by Trinity College policies and regulations, including, but not limited to, those noted below, and any rules associated with the program. Visiting students agree to comply with their home institutions policies and regulations, the points listed below, and any additional program rules. 

Compliance with Academic Policies: To study away, all students must be in good academic and social standing. For Trinity students, this means that they must not incur Academic Probation in the term prior to studying away. Since semester grades may be posted close to travel time, it is the student’s responsibility to ensure that they are in good standing before they leave campus for the semester. In addition, Trinity students must be proficient in Quantitative Literacy (QL) before studying away.  

Code of Conduct: Once admitted to a Trinity study away program, students must submit a signed copy of the Code of Conduct, acknowledging that study away is not a holiday from the regulations of the home campus, but an agreement to be respectful of local laws and social norms while in the host country. Students who do not abide by this code face the possibility of being sent home at their own expense. 

Passport and Visa: Students will be responsible for obtaining their own passport and visa (if applicable) in a timely manner, in addition to supplying the OSA (Office of Study Away) with any requested documents. Students who do not have a passport must apply for one immediately. Students who already have a passport should make sure that the passport is valid for at least 6 months after the program departure date⁄return to the U. S. Since visa requirements can change at any time, it is the student’s responsibility to stay informed of current visa requirements, and to abide by consular requirements. 

Deadlines ⁄ Required Meetings: All applicants are required to meet OSA deadlines, pay attention to all information shared during orientations (whether online or in person), and submit all application and acceptance documents by the indicated deadline. 

Health Statement and Medical Preparations: Once accepted to a Trinity study away program, students must submit a Health Statement form in order to participate. Trinity College does not discriminate against students with special needs but asks applicants to be aware that standards and methods of health care and counseling vary greatly abroad. Students who have questions about this requirement should contact the OSA. 

Insurance Coverage: All participants on Trinity study away programs receive comprehensive health coverage through International SOS. ISOS insurance provides coverage outside of the U.S. and includes health and mental health services, evacuation, and repatriation, as well as security evacuation services. The coverage does not include routine dental, optical or follow up care after students return home. Students should call ISOS to plan for their care abroad before they arrive. ISOS can answer questions on medications and arrange care on site. Students should also call ISOS to learn about vaccinations, and other travel information to help prepare for their time abroad. It is particularly important that students remain enrolled in their primary health insurance in the U.S.  

Credit Approval: It is the student’s responsibility to inform themselves of the credit approval procedures and restrictions that are outlined in the Trinity College Student Handbook and in the programs’ COMPASS website. Trinity Students must obtain credit approval from the relevant major or minor academic departments, academic advisers and the Registrar’s Office prior to their departure, by completing the Study Away Credit Approval Form (not applicable to all programs). The Study Away Credit Approval Form only needs to be completed for courses that are NOT taught directly by Trinity faculty. The only exception is if a student wishes to obtain major/minor credit or apply a course to a specific graduation requirement. Visiting students must abide by the transfer credit regulations and academic policies of their home school. 

This Application and this Agreement affirm that you will abide by the policies and regulations described in the Trinity College Student Handbook, the Bulletin, and that, once admitted, you will comply with the rules set forth in your program’s COMPASS website and by the Program's on−site staff. Ignorance of the rules will not serve as an excuse for non−compliance. Visiting students who are Trinity program applicants are additionally expected to follow the policies of their home school regarding study away participation. They will receive information on Trinity policies and regulations in their program handbooks. 

I, the applicant to the Trinity program listed and for the duration as outlined on the program website, have read the above Application Agreement and agree to comply with the rules, regulations, and policies that pertain to participation in the above-named site, if admitted to same. 

My electronic signature here indicates my understanding of and agreement with the above.

March 31st, 2024 - Fall 2024 Study Away Withdraw Deadline 

For Visiting Students: 

I am aware of my own institution's study away policies regarding housing and course registration. Further, I understand that if I withdraw from a Trinity Program after signing this form that I will be responsible for any non-recoverable expenses incurred on-site on my behalf. 

For Trinity Students:  

I am committed to studying away during the term I have been accepted for and on the specific program indicated above. I understand that the Office of Study Away (OSA) will notify college offices about my study away plans and that the college will plan for my absence during the indicated term(s) and on the indicated program(s) above. I realize that if I withdraw from my commitment to study away I am not guaranteed on-campus housing and there is a good possibility that there will not be on campus housing available. I also understand that withdrawal after course registration could result in limited availability of courses. 

I understand that I cannot withdraw from this program (or programs) and switch to another program after signing this form. Further, I understand that if I withdraw from a Trinity Program after signing this form that I will be responsible for any non-recoverable expenses incurred on-site on my behalf.   

The Trinity Rome Campus semester calendar is not finalized until the start of the semester.

Students should NOT book any personal travel plans for during the semester until after they have arrived in Rome and confirmed the dates of course trips, which will take place on dedicated course trip weekends during the semester. You will receive this information during orientation upon arrival.

March 31, 2024 - Fall 2024 Study Away Withdraw Deadline

Notice of Voluntary Withdrawal 

Notice of voluntary withdrawal from a Trinity College study away program must be made by the traveler, in writing, and sent electronically, to the respective study away advisor in the Trinity College Office of Study Away (OSA). The date of withdrawal will be determined by the date on which the OSA receives notice. 

Refunds 

• Refunds can only be made to the person whose name appears on the student account; payments cannot be transferred to another account. 

• In order to qualify for refunds in accordance with Trinity College’s standard cancellation policy, the students account must be up to date. 

• Students who withdraw from their study away program (voluntarily or per college requirement) after confirming their participation on the program will forfeit the $500 deposit (visiting students) and any other expenses incurred by the program on their behalf.  This amount will be charged to the student’s account. 

• Students who are required by Trinity College to withdraw from the program for disciplinary reasons after the start date will not receive any refund. 

• Room, meal and excursion charges may be partially refundable depending on the program and when official withdrawal occurs. 

• International insurance is refundable for remaining days left of the program after official withdrawal occurs. 

Refund Schedule 

If official withdrawal occurs after classes begin, the following schedule reflects the amount of tuition and fees that will be refunded: 

First and Second Week 80% 

Third Week 60% 

Fourth Week 40% 

Fifth Week 20% 

After Fifth Week 0% 

Wherever possible, the Trinity College Study Away Withdrawal and Refund Policy reflects the college’s refund policy on campus (https://www.trincoll.edu/student-accounts/policies/tuition-refund-policy/ ). 

I understand that registration constitutes a contractual financial obligation to pay tuition, fees for which I am liable each term enrolled.  I understand that I am also responsible for all costs incurred for room, board, damages and other charges during my enrollment at Trinity College (less financial aid received).  I understand that payments not made when due are subject to late fees and collection charges including attorney’s fees, if applicable.  I agree to reimburse the College the maximum allowable fees by CT law of any collection agency, which may be based on a percentage at maximum of 33.3% of the debt or 40% for a legal account, and all legal and court costs and expenses, including reasonable attorney’s fees, incurred by Trinity College in such collection efforts.  I understand and agree my financial obligation to Trinity College constitutes an educational loan to assist in financing my education and therefore is not dischargeable, pursuant to United States of Bankruptcy Code section 523 (a) (8).  In addition, I authorize Trinity College and their respective agents or contracted vendors to contact me regarding my loan or student account balance including repayment of my loan or student account balance, at the current of any future number that I provide for my cellular phone or other wireless devise using automated telephone dialing equipment or artificial or pre-recorded voice or text messages.

Bills for tuition, fees, room and board are payable before the opening of each semester on the dates shown in the College calendar.  Any individual who fails to pay all charges by the specified due dates will not be allowed to attend class, register, utilize campus facilities, be provided transcript or grade reports, or be allowed to graduate.

Billing statements are issued electronically through the TrinBillPay system.  Students must set up Authorized Payer accounts for each parent or person who may be assisting them with payment.  It is the student’s responsibility to access and view their student account billing activity each month.  Billing notices are delivered monthly from student-accounts@trincoll.edu to each student and all Authorized Payers on record at time of billing.

I  have read and agree to abide by the terms set forth above in the Statement of Student Financial Responsibility:

Student signature:                                                                                                             Date                                  

         Student Name and Identification Number Information (Please Print)

         Student’s Name:                                                                                   ID # _____________

                                             Last,             First,           Middle Initial

         Student Social Security Number: _ _ _ - _ _ - _ _ _ _  *

*(Trinity College is required to collect social security numbers or TIN to meet federal and state reporting requirements.  We

 provide SSN’s to the federal and state government authorities and to our contracted business partners who are mandated by

 contract and federal law to protect your confidentiality.  Social security numbers are confidential and exempt from public

records). Trinity College will generate a Form 1098T for Education Tax purposes only if a valid SSN is on file at time of

 reporting.

Billing statements are issued electronically through the TrinBillPay system.  Students must set up Authorized Payer accounts for each parent or person who may be assisting them with payment.  It is the student’s responsibility to access and view their student account billing activity each month.  Billing notices are delivered monthly from student-accounts@trincoll.edu to each student and all Authorized Payers on record at time of billingI  have read and agree to abide by the terms set forth above in the Statement of Student Financial Responsibility.

Students living in the apartments will be expected to:

• Participate in extracurricular events /cultural life on campus

• Be responsible, flexible and mindful of his/her roommates’ needs

• Commit to providing a safe, inclusive, supportive and positive residential experience for all those living in the apartment

• Regularly participate in Italian language activities organized by the program

• Be aware that there is no Italian language requirement to apply but preference will be given to students who have studied college-level Italian before arriving in Rome

• Utilize any chance to practice and improve his/her knowledge of Italian language

• Be respectful of the apartment property and all items provided for student use owned by the apartment

• Draw on the immersive experience of living with Italians to complete co-curricular assignments for your Italian course during the semester

• Submit a brief reflection of their experience living in the apartment at the end of their semester

CO-ED - Do you agree to live in a coed apartment with gender-separated bedrooms?  

This is a required form. It must be submitted, with your electronic signature, to show your acceptance of the offer of admission and your agreement with the terms of admission.

I am over age 18, and I have been accepted for study at the Trinity Rome Campus in Rome, Italy.

I understand that in any international travel and residence there are risks that I must normally and reasonably assume. I hereby assume those risks knowingly and willingly.

I have the opportunity to gain certain academic credit through participation in this Trinity Program and in consideration of the costs of such Program and other good and valuable consideration, I do hereby release Trinity College and each of its trustee, director, officer, employee, servant, or agent from any and all liability for any negligent act or omission of any kind or character whatsoever, and release them from any costs, damages, and claims or assertions of any kind with respect to which I or my heirs, successors or assigns may claim against them and specifically with limitation agree to release them from any liability for injury to myself or any damage to or loss of my possessions caused by acts or omissions of any hotels, carriers, other students, restaurants, educational organizations, housing providers, transportation providers, persons, groups or organizations, including, but not limited to Trinity College and each of its trustee, director, officer, employee, servant or agent of either of them in connection with the work or study or other activities there under.

Furthermore, Trinity College and its trustees, directors, officers, employees, servants, representatives, and agents shall not be or become responsible or held liable for any loss, injury or damage resulting from the following: acts of God or nature, accidents, incidents at sea, fire, breakdowns in machinery or equipment, acts of governments or other authorities, acts of war, acts of terrorism, hostilities or civil disturbances, strikes, riots, theft, pilferage, epidemics, quarantines, medical, physical, or psychological situations, customs or other regulations, delays or cancellations in airline, train, bus, or automotive vehicle schedules, or from causes beyond their control.  In addition, I understand that this Agreement includes my travel to and from and any and all other travel incident to my study and⁄or participation in the Trinity Program. Side excursions and independent travel not associated with the Trinity Program will be completed at my own risk.

I have read and understood the foregoing, and if I am unable to do so for whatever reason, I have had them read to me and am confident that the individual so doing has read and⁄or translated the statements truthfully and in their entirety. I acknowledge that I am of the specified legal age in the state or country of my residence to bind myself to this Release and Waiver of Claims and I accept and agree to be bound by the conditions and terms stated therein. I execute this document voluntarily, without coercion from anyone. The validity, effect, and operation of this Agreement shall be determined by the laws of the State of Connecticut.

I authorize Trinity College to photograph, film, tape, and/or interview me (or person of whom I am a legal guardian), and I agree that Trinity College may use any material and/or quotes, films or negatives, films or tapes (audio or visual), or digital images as they desire. I also understand that such material may be used for publication, College websites, social media, podcasting, and/or broadcast purposes. I relieve and hereby agree to hold harmless Trinity College and its agents and employees from any and all liability arising out of the photography, filming, taping, and/or interviewing. I understand that these activities will be carried out with my consent and I assume full responsibility for granting that consent. 

After students confirm their spot at the Rome Campus they will provided with the Trinity College Rome Campus COMPASS website. 

Students are responsible for understanding the contact on this website and must abide by all the important dates, policies, and rules.

The Office of Study Away will be in contact with people whom you selected as your emergency contact to provide them with application and program information. If you do not want the OSA to provide this information please select NO below. 

The rules regarding proper behavior abroad are defined by your home campus, Trinity College, your program, and the laws of your host country. You will be responsible for observing the rules pertaining to student conduct contained in the Trinity College Student Handbook, as well all rules and regulations conveyed to you by Trinity College staff both in Hartford and on-site. You are also responsible for abiding by the laws of your host country. Visiting students are responsible for complying with Trinity's policies as well as their home institutions' rules and regulations.  

Trinity students who study away (and visiting students participating in a Trinity program) are expected to know and abide by all College regulations. While studying away, students are representing themselves, their institution and their country and are expected to exemplify acceptable student conduct, as outlined in the Trinity College Student Handbook, in all interactions including social media.

Conduct that is unbecoming of a Trinity College student includes, but is not limited to disturbance of the peace; disorderly or indecent conduct; physical or verbal abuse or assault; threats; intimidation; coercion; any conduct that threatens, instills fear, or infringes upon the rights, dignity, and integrity of any person; any conduct likely to lead to violence; harassment.

Students are expected to be:

• Respectful, careful, responsible and accountable for their use of social media.

• Understand the lack of privacy inherent in social media.

• Gracious and tolerant both in the statements they make and the photos and videos they post.

The Office of Study Away (OSA) may monitor the language and/or actions of study away students on public social media platforms, including Facebook, LinkedIn, Twitter, Instagram etc. The OSA will hold students accountable for abusive or disrespectful postings.

My electronic signature here indicates my understanding of and agreement with the above.

Illegal drug, purchase, possession, use or distribution while participating in a Trinity−administered Program is strictly forbidden.

If you fail to abide by this regulation, you place yourself at significant personal risk. By accepting your place on the program, you acknowledge that Trinity College would not be responsible or liable for any results of such behavior (nor would the college's faculty or staff). 

Due to the potential severity of consequences to your well-being and safety, and those of other students on the program, infractions of this regulation make one liable for immediate expulsion from the Program.

My electronic signature here indicates my understanding of and agreement with the above.

Irresponsible use of alcohol and drunken behavior while participating in a Trinity−administered Program is strictly forbidden.

If you fail to abide by this regulation, you place yourself at significant personal risk. By accepting your place on the program, you acknowledge that Trinity College would not be responsible or liable for any results of such behavior (nor would the college's faculty or staff). 

Due to the potential severity of consequences to your well-being and safety, and those of other students on the program, infractions of this regulation make one liable for immediate expulsion from the Program.

My electronic signature here indicates my understanding of and agreement with the above.

Trinity expects each student studying away to abide by the highest standards of intellectual honesty in all academic exercises.

Students must do their own work and must credit properly those upon whose work and thought they draw in every examination, quiz, paper, laboratory report, or other academic exercise completed for a course on a Trinity−administered Program.

My electronic signature here indicates my understanding of and agreement with the above.

Students are responsible for the condition of their rooms and their furnishings during periods of occupancy. Damage and⁄or loss of Program property are the financial responsibility of the resident⁄Program participant.

Damage to or loss of Program property, including cell phones, as well as damage to the furniture, walls, or any part of one's room (whether home stay, rented apartment, dormitory room, or Program−owned⁄−leased space) will be assigned a repair or replacement cost and charged to the responsible student's Trinity College bill.

My electronic signature here indicates my understanding of and agreement with the above

Road fatalities are the leading cause of death for undergraduate students studying abroad. As a result, students studying abroad may not drive or rent cars, mopeds or motorbikes in foreign countries. 

Yes, I understand

The on−site director⁄coordinator may require a student's immediate withdrawal from the Program (with subsequent loss of fees paid and academic credit) if, after appropriate consultation, it is determined that the student has violated any regulation or has acted in a manner detrimental to and⁄or incompatible with the welfare of the Program, including emotional or psychological problems that are detrimental to and⁄or incompatible with the welfare of the Program.

Violations may also result in censure, which will be noted on the Trinity transcript.

Since no set of regulations can anticipate every contingency, participating students are expected to show maturity, reasonable discretion, and consideration for the rights of others and for local cultural norms while attending a Trinity−administered Program.

By checking above, you agree to the following, as well as the information indicated above:

As an intended participant in a Trinity−administered Program, I have read the regulations and understandings set forth and referred to here and in the Trinity College Student Handbook. I pledge to abide by these codes fully. I accept the authority of the on−site director⁄coordinator and recognize that he⁄she has the right to send me home for non−compliance. I agree to abide by program rules and regulations detailed in my program handbook, the Study Away Pre−Departure Orientation Guide, and other materials provided to me by Trinity on−site staff, including host university personnel, if applicable.

The Office of Study Away (OSA) aims to work with students studying away on Trinity programs to maximize support for their health and safety.  Studying away is an extremely rewarding, but also challenging experience that can be both physically and emotionally stressful.  To assist the OSA to best prepare you for studying away, it is very important for you to complete this health questionnaire.  Please answer honestly and be as comprehensive as possible. Be sure to include all information that you think may be relevant regarding any past or present health conditions (physical or psychological). This information does not affect your admission to the program. Please note that special accommodations available to you at Trinity may not be available to you abroad.

It is very important for you to check with the CDC www.cdc.gov for health-related information for your host country and other countries you plan to visit. Ensure that you are up to date on all vaccinations; Trinity strongly recommends that you obtain all additional vaccinations recommended by the CDC.

The information you provide will be reviewed by OSA and will be released to your study away program staff to enable them to be better prepared to assist you and address your health needs on-site.  In addition, note this information may be released to emergency and health care professionals when health conditions warrant. Please note: If you require special accommodations, you must meet with the OSA as early as possible. The OSA will work with you to assess whether or not the accommodation can be made on the program and will assist you in locating options as feasible.

Please list all prescription and non-prescription medications that you currently take. Note that it is important that you continue to take all medications while you are studying away and you should prepare to take a supply of medications with you that will last for the duration of your stay. Important: While many medications are available abroad, some are not and may be illegal to obtain in your host country. For example, ADHD medications are illegal in many countries. You are responsible for ensuring that you can travel with your medications and that you have or access to a supply of all medications that you will require. Trinity is not responsible for your medication. 

Trinity College does not employ physicians or healthcare providers at its study away programs. Standards of health care vary greatly country-by-country, and different cultural norms impact treatment. If you have a continuing or past medical condition that may be a concern abroad You must consult with a medical professional before departure to make an informed decision about your participation in a study away program, discussing the potential stresses and medical consequences of study abroad, as well as an appropriate, self-researched treatment program. It is important that you are aware that English-speaking and/or U.S. trained physicians and health care providers may not be readily available on-site. 

I have read and understand

As with physical health, Trinity College does not employ mental health professionals at its programs abroad. In general, treatment of mental health conditions is not as widely accessible in many countries as it is in the U.S. The standards of mental health services vary greatly overseas, and different cultural norms also impact treatment practices. If you have an emotional or psychological condition, we ask, for your own welfare, that you consult with a mental health professional in this country to make an informed decision about your participation in a study away program, discussing the potential stresses of study abroad, as well as an appropriate, self-researched treatment program. It is important that you are aware that English-speaking and/or U.S. trained therapists and counselors may not be readily available to program participants. 

I have read and understand

I certify that all responses made on this form are complete, true and accurate. I understand that if there are any changes in my health status, I will contact OSA immediately. I understand that if I misrepresent or fail to provide the information requested on this form, then I may be barred from participation in or dismissed from the study abroad program I have chosen. I understand that OSA will do its best to accommodate my needs, though not all accommodations may be possible. I agree that the information in this form may be disclosed to Trinity personnel, anyone associated with the study away program with a need to know, and emergency and health care professionals. I grant the officers, employees, representatives, servants, or agents of Trinity College the authority to take whatever action they feel warranted regarding my health, safety, and welfare. This authority will permit its said officers, employees, representatives, servants, or agents to place me, at their discretion and at my (or my parents') expense, in a hospital for medical service or treatment or, if no hospital is available, in the care of a local medical doctor for treatment. The officers, employees, representatives, servants, or agents are further authorized to fly me back to the United States at my (or my parents') expense, if it is deemed necessary by the Program following consultation with local medical authorities. I agree to read the information about health and safety provided in my pre-departure and orientation materials.

Please initial and date in the box below to acknowledge your understanding and acceptance of these terms and to verify that all information provided is true and accurate to your knowledge.