1. SW VIRGINIA INTERNATIONAL STUDY IN GERMANY
May 19 – June 1, 2013
APPLICATION PACKET
One Partnership Circle
P. O. Box 1987
Abingdon, VA 24212
Fill out this application packet in its entirety:
1. Application
2. Health Information Form
3. Assumption of Risk and Condition of Participation Form
Attach to the packet:
1. Your non-refundable application fee for $250.00 (See Background Information).
2. Completed essays (See Background Information).
Make arrangements to have sent to SVHEC: (Student Applicants only)
1. Copy of official transcript from your college or university.
2. Letter of recommendation form completed by your college or university.
(Please use a sealed envelope with the recommender’s signature across the back.
Transcript and letter of recommendation may be received after application deadline.)
Completed application packet should be mailed to:
George L. Hiller, J.D.
Director of International and Internship Programs
Southwest Virginia Higher Education Center
P O Box 1987
Abingdon, VA 24212
Tel.: (276) 619-4374
Fax: (276) 619-4309
E-mail: ghiller@swcenter.edu

2. APPLICATION DEADLINE: DECEMBER 5, 2012
BACKGROUND INFORMATION
SW VIRGINIA International Study in Germany 2013
The U. S. Department of Education and the Virginia Tobacco Commission have awarded
the Southwest Virginia Higher Education Center grants to support a series of
international business study trips to Germany for faculty and students at colleges in far
SW Virginia. Dr. Amelia Harris from UVA-Wise and Mr. George Hiller from the SW
Virginia Higher Ed Center are the program leaders.
Please note the following:
1. Participants must be at least 18 years of age.
2. A non-refundable application fee check of $250 payable to the “SW Virginia
Higher Education Center” is due with your application. However, if you are not
selected for the program, your check will be promptly returned to you.
3. Participants will be responsible for reserving and paying for their own airplane
tickets to/from Europe. Our travel agent will provide information for the flight and
will assist participants with the reservation. We will depart on May 19th and return
on June 1st . Participants may depart for Germany before May 19th and stay over
in Europe after June 1st if they wish, but will need to make those arrangements
themselves. Our travel agent can also assist with that. We will have a bus to
pick up the group at the airport on Monday morning, May 19th.
4. All participants MUST participate in the entire program that will conclude in
Berlin, Germany on Friday morning, June 1, 2013. We reserve the right to
dismiss any participant from the tour who does not join in all activities.
5. There is no additional participation fee. Via our grants, we will cover:
lodging/breakfast, ground transportation in Germany, admission fees, ground
program, and some group dinners.

3. 6. One hour of academic credit will be available via UVA-Wise for an additional fee.
7. You must have a passport from the US or another country that is valid until at
least November 1, 2013. The U.S. Passport application fee, to be paid by you,
is approximately $160. Please note the U.S. passport application process may
take up to two months to complete. You should request your passport as soon
as possible. (There is no visa required for travel to Germany.)
8. The SW Virginia Higher Education Center will arrange and pay for emergency
health insurance coverage for each participant.
9. All selected faculty and student participants will be required to attend a pre-trip
briefing session. This will be scheduled for March, 2013 and is obligatory.
10. Along with your completed application student applicants should please include
two essays of approximately 200 words:
a. Why is it important for SW Virginia students to learn about other
cultures, including international business and technology?
b. Briefly explain your current career goals including international
interests.
Preference for participation will be given to faculty and students from: Emory & Henry
College, King College, University of Virginia’s College at Wise, Virginia Intermont
College, Mountain Empire CC, Southwest Virginia CC, Virginia Highlands CC, and
Wytheville CC. Students at other colleges and universities who are legal residents of
SW Virginia are also encouraged to apply. The preference is for students majoring or
minoring in business, economics, sciences, engineering, math, and technology as well
as faculty in those disciplines. However, faculty and students from all academic
departments are invited to apply.

4. APPLICATION FORM
SW VIRGINIA INTERNATIONAL BUSINESS STUDY IN GERMANY 2013
SW VIRGINIA HIGHER EDUCATION CENTER (SVHEC)
________________________________________________________________
A. Personal Information
Legal full name: ____________________________
Preferred name: ___________________________
Sex: M F Birth date: ______________
Social Security Number: ________________________________
Are you a U.S. citizen? Y N
If YES, do you have a U.S. Passport? Y N
Passport Number: __________________ Expiration Date: ___________________
If NO, country of citizenship and passport number: _____________
Campus address: ____________________________
_____________________________
Home address: _____________________________
_____________________________
Telephone(s): _______________________(H) ____________________ (C)
E-mail: ____________________________
Emergency contact person(s) (name/telephone):
______________________________________________
______________________________________________

5. B. Academic Information
College or university where enrolled:
____________________________________________________
Year in school as of August 2013 _______________
Major/ Intended Major: ______________________________ Current GPA: __________
Minor: __________________________________________
Are you in good standing judicially at your current school? Y N
If NO, please attach an explanation to this application.
Have you ever been convicted of any crime, excluding minor traffic violations that did not
involve bodily injury to others? Y N
If YES, please attach an explanation to this application.
Have you ever been sanctioned by your college or university for a violation of their
standards of conduct? Y N
If YES, please attach an explanation to this application.
I have also read and understand the “Background Information” including the pre-trip
meetings requirements.
Signature: __________________________
Date:_______________________________

6. HEALTH INFORMATION FORM
SW VIRGINIA INTERNATIONAL BUSINESS STUDY IN GERMANY
SW VIRGINIA HIGHER EDUCATION CENTER (SVHEC)
Medical and Special Considerations Self-Disclosure:
Instructions:
The purpose of this form is to help SVHEC and the directors of the SW Virginia
International Business Study in Germany be of maximum assistance to you should the
need arise during your education abroad experience. Mild physical or psychological
disorders can become serious under the stresses of life while abroad. Although you
have the right not to disclose your medical conditions or special needs, we strongly
encourage you to do so. It is important that the program be made aware of any medical
or emotional problems, past or current, which might affect you in a foreign study context.
Except for the directors of the International Business Study in Germany Program, the
information provided will remain confidential and will be shared with faculty or
appropriate professionals only if pertinent to your own well-being. SW Virginia
International Business Study in Germany directors will do their best to accommodate all
disclosed individual needs or circumstances, although sometimes this is not possible.
Undisclosed needs cannot be accommodated and may in certain cases lead to student
or faculty withdrawal from the program. (You may add an additional page, if necessary.)
1. Do you have any chronic or long-term health condition? Yes____
No____ If yes, please specify below.
2. Have you ever been, or are you currently being, treated for any
psychological or emotional problems? Yes_____ No_____
If yes, please specify below.
3. Do you have a learning disability documented with your home university?
Yes______ No______ If yes, please specify below
4. Do you have any other disability or special needs that require
accommodations?
Yes______ No______ If yes, please specify below
5. Do you have any dietary restrictions? Yes______ No______
If yes, please specify below.

7. ASSUMPTION OF RISK and CONDITIONS OF PARTICIPATION
SW VIRGINIA INTERNATIONAL BUSINESS STUDY IN GERMANY
SW VIRGINIA HIGHER EDUCATION CENTER (SVHEC)
Read CAREFULLY and initial on each line indicating that you
understand and agree with the specified statement.
Travel Risks
I realize that international travel and study, including participation in study
abroad, involves significant inherent hazards and risks, both foreseeable and
unforeseeable, including travel in difficult terrain and inclement weather; inadequate or
unhealthy food and water supplies; accidents or collisions involving planes, trains,
buses, automobiles, or other modes of transportation; acts of terrorism, vandalism, or
war; storms, earthquakes, or other natural disasters; government restriction or
regulation; theft or other criminal acts; and accident or illness in remote locations without
access to appropriate medical facilities. These risks and hazards may result in serious
physical injury, illness, death, and damage to or loss property, and I assume all such
risk.
In consideration of the Southwest Virginia Higher Education Center (SVHEC)
permitting me to participate in this experience, I hereby release and covenant not to sue
and forever discharge SVHEC, its Trustees, officers and employees and students from
all claims, demands, liabilities, damages, and losses arising out of, or in any way related
to my selection of or participation in, or in any way connected with my time abroad.
_____I have carefully read the US Dept. of State Consular Information Sheet for
Germany: http://travel.state.gov/travel/cis_pa_tw/cis/cis_1123.html
Academic Policies and Procedures
The SW Virginia Study in Germany program is first and foremost an academic
experience. Participants are expected to participate to the fullest extent of the program
(i.e., orientation, classes, group trips and activities, standards of academic work and
responsible conduct). The directors reserve the right to dismiss any participant from the
tour who does not join in all the activities.
Code of Conduct
The program arranged by SVHEC is a supervised program and certain
standards must be observed. All participants must at all times comply with SVHEC rules,
standards, and instructions for student conduct and behavior as well as any stated
codes of conduct from the host institution/agency. SVHEC reserves the right to enforce
appropriate standards of conduct and specifically reserves the right to terminate the
participation of any student for failure to maintain these standards or for any actions of
conduct which SVHEC considers to be incompatible with the interest, harmony, comfort
or welfare of participants.

8. In particular, either possession/consumption of controlled substances (by U.S.
definition, or that of any other country visited) or alcohol impairment/abuse may result in
immediate termination from the program. Participants are expected to act responsibly at
all times.
If any participant should have his or her participation terminated in accordance
with conditions above, then SVHEC shall have the right to require the participant to
leave the program without refund of participation fees.
I understand that during free time within my international experience, my
absence from my study abroad classes or group activities, and during my independent
travel, neither SVHEC nor my host staff is responsible for me and/or my actions.
I understand that as an American citizen (or foreign citizen) in another country, I
will be subject to the laws of that country. I agree to conduct myself in a manner that will
comply with host country laws and with the regulations of my host university and/or
program. I understand that the program has the right to terminate my participation in the
program if, in the judgment of my hosts, my conduct is unacceptable and/or disruptive.
Cost and Payments
I understand that I am solely responsible for all costs incurred by and related to
my voluntary participation in my international program or experience.
I understand that I am solely responsible for any and all costs arising out of my
own voluntary or involuntary withdrawal from my international experience prior to its
completion, including withdrawal caused by illness or disciplinary action.
I understand that I am required to have adequate health, accident, and
evacuation insurance to cover myself during participation in the program, including travel
before and after my program.
Authorization and Agreement:
 I certify that the information on application for this international experience is true
and accurate.
 I hereby waive my right of access to letters of reference, which may be submitted
in support of my application.
 I understand that if any information is found to be false, my application to
participate in my international experience will be terminated.
 I hereby grant permission for the program directors and the SVHEC
administration to contact those listed as my emergency contact, and/or either of
my parents, if such contact is determined to be appropriate under the
circumstances. Such circumstances include, but are not limited to: illness or
injury, disappearance, arrest or detention by law enforcement agencies, or
dismissal from the program.

9. By signing this document, I hereby acknowledge that I understand and
accept the above costs and conditions of this activity.
______
Signature of Participant Date
Printed Name of Participant

10. SW VA INTERNATIONAL STUDY IN GERMANY
MAY 2013
Faculty Recommendation Form
Return to:
George L. Hiller, J.D.
Director of International and Internship Programs
Southwest Virginia Higher Education Center
P.O. Box 1987
Abingdon, Virginia 24212
___________________________________
Full name of applicant
Student Waiver Statement: In accordance with the “Family Educational Rights and Privacy Act of 1974” it
is recognized that students enrolled in this study abroad program have the right to inspect and review all
materials in their files unless they sign the following statement:
I understand my right under the provisions of PL 93-380.513 as amended 20 US Code
Section 1232G et al. to inspect letters of recommendation on my behalf. In order to encourage the
authors of letters about me to write with candor, I have elected not to exercise my rights under the
aforesaid statute and affirm that I shall not do so in the future. This waiver will remain in effect
until I notify, in writing, the University, at which time this document will be removed from my file
and returned to the author, or until this recommendation is destroyed.
__________________________________ ______________________________
Signature of applicant Date
INSTRUCTIONS TO THE INDIVIDUAL COMPLETING THE RECOMMENDATION FORM:
The applicant is responsible for returning this form to us. Please put the completed form in a sealed
envelope and sign the back for security. Please return the recommendation to the applicant.
1. How long have you known the applicant?
_______________________________________________________
2. In what context have you known the applicant:
___________________________________________________

11. 3. Please rank the applicant on the traits below. Circle the most appropriate ranking for each trait using the
following scale: (U=Unknown; 1=Poor; 2=Fair; 3=Good; 4=Excellent).
Academic ability U 1 2 3 4 Able to communicate in German U 1 2 3 4
Adaptability U 1 2 3 4 Intellectual curiosity U 1 2 3 4
Ability to communicate U 1 2 3 4 Dedication/seriousness U 1 2 3 4
Ability to cooperate U 1 2 3 4 Self-reliance U 1 2 3 4
Emotional stability U 1 2 3 4 Ability to withstand stress U 1 2 3 4
4. What is applicant’s strongest attribute?
5. What characteristic might be a liability on a study-abroad program?
6. Please indicate your opinion of this individual and her/his chance of success in this study abroad
program?
7. Considering your overall evaluation of this applicant, what is your recommendation with regard to
her/his acceptance to this study abroad program:
Do Not Recommend Recommend with Reservation Recommend Strongly recommend
Name of Reference ____________________________________Title ______________________________
Signature ___________________________________________ Date _____________________________
Address ____________________________________________Phone ( ) ________________________
E-Mail_____________________________________________
Thank you for your time and consideration of this individual.