MONMOUTH COLLEGE
DEAN OF STUDENT'S  RECOMMENDATION
FOR OFF-CAMPUS STUDY


Student:__________________________________

Off-campus semester _______________________ 

Program: _________________________________

I  am aware of the physical and emotional requirements of the study abroad experience and I am prepared to meet them. I understand that, if I have any medical conditions requiring specialized care, I am advised to consult with a physician before enrolling.

I also authorize that this form to be sent to the Monmouth College Dean of Students Office and waive my rights to this information . 

___________________________________ ___________________________
Student signature
 		 Date
 

The above student is applying the Curriculum Committee to participate in and to receive transfer credit for successful completion of the listed study abroad program. Please complete this form and return it directly to Tom Sienkewicz, Study Abroad Coordinator. Your signature indicates consent for release of this information to the selected program.

1. This student is a full-time undergraduate in good academic and judicial standing at Monmouth College.

Yes______  No______


2. Has this student ever been on academic probation?

No______  Yes______ (Please explain.)


3. Has this student been subject to disciplinary action?

No______  Yes______ (Further information provided to the committee upon request.)


4. Do you support this student’s petition to participate in the above study abroad program?

Yes______  No______  Yes with reservations ______ (Please explain)


5. Please use the back of this sheet for any additional comments regarding this student’s eligibility and/or qualifications for study abroad.
 

________________________________________________ _____________________
Printed name and signature of Dean Date

Note: This form should be sent directly by the Dean to the Coodinator of Off-Campus Study. It should not be returned to the student.