2015 JSA Diplomat Forms Packet

Checklist & Forms
*We strongly urge having this checklist on your refrigerator* Checklist of To Do’s & Important Forms Date Due Return Tuition Payment Form (page 21) and applicable payment. Return Parental Permission Form (page 19). Apply for Chinese visa through CIBT (page 26). Make an appointment with your child’s pediatrician. Return Air Travel Arrival/Departure Information Form (page 25). Return Physician’s Signature Form (page 24). Immediately Immediately Immediately Immediately May 1st May 1st May 1st No later than May 26th Pay tuition balance Please refer to page 20, your course selection-­‐ is not guaranteed until your tuition is paid in full Submit passport bio page and visa scan Authorization to Visit/Take Student Off Campus (optional) June 1st Bring on Opening Day Room Key Deposit(s) A 300 RMB deposit will be due upon check-­‐in in Beijing. RMB can be obtained at ATM’s and banks near campus and at the airport. Immediately Make travel arrangements with airline, train, bus, etc. for the Seattle Orientation Program within approved dates and times (please refer to page 10 for dates and times). Return Medical Information Form (page 22) with a copy of your Medical Insurance ID Card (both sides). Due in Beijing Internet Fee If you are bringing a personal computer, and want to use the internet in the dorm, the fees will be paid in RMB on campus in Beijing. The amount varies depending on campus location Due in Beijing Forms may be submitted separately. When sending forms or payment, please use one of these methods: JSA Summer School 1411 K St. NW, Suite 200 Washington, DC 20005 United States By Email By Mail By Fax (please bring originals on Opening Day) (please bring originals on Opening Day) summerprograms@jsa.org 2015 JSA DIPLOMAT PROGRAM ORIENTATION GUIDE (202) 296-­‐7839 19 Par ental Per mission For m
Student Information Student Name City State Zip Student Email Gender: Male Female Home Address Age High School Passport Number Passport Expiry Date Phone Birth Date / / (mm/dd/yyyy) High School Graduation year: Place of Birth and Citizenship Parent/Guardian Statement I have read the Orientation Guide, and I agree to allow my son/daughter to attend the 2015 JSA Summer School, subject to all rules governing con-­‐ duct both on and off campus. I understand that my son/daughter may be sent home during the session for any serious conduct violations or for health reasons. I understand that if the student withdraws early from the program, or if he/she is sent home for health reasons or for violation of the rules and regulations of Chinese law, the JSA Diplomat Program, Capital Normal University, or any public law, that no refund will be given and no academic credit will be received. I grant permission to the JSA staff and/or CET staff to authorize medical personnel to provide all necessary medical care to the student. I give permission for the JSA staff and/or CET staff to dispense the limited over-­‐the-­‐counter medicines outlined in the medical form and understand the student will be responsible for taking his/her own prescription medications. I give permission for the nearest or most appropriate medical facility to provide routine health care for the student; to order x-­‐rays, tests, or treatment; and to release any records necessary for insurance purposes. In the event I cannot be reached during an emergency, I give permission for the physician selected by the JSA staff and/or CET staff to secure and administer treatment, including surgery or hospitalization, for my child. I give permission for JSA and/or CET to contact the student’s medical provider for the purpose of confirming medical conditions/treatments or obtaining additional information in order to provide appropri-­‐ ate care. The authorization shall be in effect while my child is a student of the JSA Diplomat Program. I understand I am fully responsible for the student’s medical costs. I understand and agree that additional costs to house, feed, and transport the student home after the last day of his/her program is my financial responsibility. If the student is delayed in leaving for any reason after the last day of the program, I agree to pay at least $50 per night past that date. Also, I understand this option is to be used only in emergencies and is not available as an optional extension. I understand and agree that the Junior Statesmen Foundation or CET Academic Programs may use photographs taken of my son/daughter while at the JSA Diplomat Program at Capital Normal University for future promotional purposes. I understand and agree that the Junior Statesmen Foundation or CET Academic Programs may use statements written by my son/daughter while at the JSA Diplomat Program at Capital Normal University for future promotional purposes. Date Parent Signature STUDENT STATEMENT -­‐ I have read the Orientation Packet and I agree to abide by all the Summer School rules. I understand that in the event of a serious violation of the rules, my parents will be notified and I may be sent home at my own expense, with no refund or academic credit awarded. Date Student Signature The U.S. Department of Education requires that we collect and report race and ethnicity data on our students. The parent or legal guardian of the student is required to answer the following questions. (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish (1) Is this student Hispanic/Latino? (choose only one) Yes No culture or origin, regardless of race) (2) What is the student’s race? (choose only one) American Indian or Alaska Native. (A person having origins in any of the original peoples of North and South America, including Central America, who maintains a tribal affiliation or community attachment.) Asian. (A person having origins in any of the peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.) Black or African American. (A person having origins in any of the Black racial groups of Africa.) Native Hawaiian or Other Pacific Islander. (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.) White. (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.) (3) Does this student participate in the federal free/reduced lunch program at his/her school: 2015 JSA DIPLOMAT PROGRAM ORIENTATION GUIDE Yes No 20 Payment Infor mation
The JSA Diplomat Program tuition of $6,500 covers classes, workshops, university educational facilities, housing and meals, guid-­‐ ance and supervision, as well as textbooks and other academic expenses. Option 1: Tuition in full is due within 10 business days after receipt of acceptance letter and Orientation Guide. Option 2: If paying tuition in full poses a hardship, then students must take the following steps within 10 days after receipt of acceptance letter and Orientation Guide to avoid being Wait Listed. 1.
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JSA Members: Email summerprograms@jsa.org -­‐ Payment plan agreement will be emailed to you. Non-­‐JSA Members: Contact Mr. Slade Jones at 202-­‐486-­‐0651 or sjones@jsa.org -­‐ Payment plan agreement will be emailed to you. Visit www.summer.jsa.org/fundraising to learn about and sign up for a JSA Fundraising Academy Webinar offered each week on Tuesday and Wednesday evenings. Start an online fundraising webpage at www.jsa.org/summerfundraising Accepted students will be Wait listed if no payment plan is set up within 10 days after receipt of acceptance letter and Orientation Guide. When a program’s seating capacity is reached, Wait Listed students are notified and may be un-­‐enrolled from the program if they do not adhere to the agreed upon payment plan. • Due to limited space in each program, your seat is only guaranteed when tuition is paid in full. PAYMENT OPTIONS For any payment, always include the NAME of the student and the PROGRAM the student is attending (i.e. John Doe, Stanford) •
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BY CREDIT CARD We accept Visa, MasterCard, American Express and Discover. Pay by completing the Tuition Payment Form or by phone at (800) 317-­‐9338 BY CREDIT CARD -­‐ ONLINE Please send an email to summerprograms@jsa.org and request an online payment link to your invoice or make payment online through MyJSA account. BY CHECK OR MONEY ORDER Please make checks payable to the Junior Statesmen Foundation. Include the name of the student and the program they are attending on the check (i.e. John Doe, Stanford). Send all check/money orders to: JSA Summer School 1411 K St. NW | Suite 200 Washington, DC 20005 DOMESTIC OR INTERNATIONAL CABLE Please call (800) 334-­‐5353 or (650) 347-­‐1600 for routing number and instructions. Partial scholarships are available from the Junior Statesmen Foundation. Students may submit a scholarship application at any time before May 1, 2015. The JSA Scholarship Application is available at www.summer.jsa.org/support/scholarships/ REFUNDS Tuition payments (minus a $75 administrative fee) made by the immediate family (parents, grandparents, brothers and sisters) are fully refundable as long as the Junior Statesmen Foundation receives notice in writing at least 15 business days before the start of your program. After this date, all tuition fees paid become non-­‐refundable, but will remain on the student’s account to be used for any future JSA Summer Programs or events.
• Junior Statesmen Foundation scholarship funds are not refundable at any time. • All refunds must be requested in writing at least 15 business days before the start of your program. • There will be no refund of tuition for any students who withdraw for any reason before the end of the session or who are dismissed for disciplinary or other reasons. 2015 JSA DIPLOMAT PROGRAM ORIENTATION GUIDE 21 Tuition Payment For m
Student Name Home Address City State Zip The JSA Diplomat Program tuition is $6,500. Tuition is due within 10 business days of receipt of your accep-­‐ tance letter and Orientation Guide. Students who are actively fundraising should call our office at (800) 317-­‐
9338. If any service clubs, other organizations or family friends are making a sponsorship contribution in your name, they can mail a check directly to the Junior Statesmen Foundation office with a note indicating that you raised the money. If you have any questions about scholarships or tuition, please visit www.summer.jsa.org/support or contact us at (800) 317-­‐9338. PAYMENT INFORMATION Enclosed is $6500, my full tuition payment Enclosed is $1000 for the Shanghai Extension Enclosed is $1650 for the group airfare and pre-­‐departure orientation Other amount $ We are paying by: Check (made payable to the Junior Statesmen Foundation) Visa MasterCard Card Number American Express Exp. Date Card Holder’s Name Discover VISA, MC, DISC: 3-­‐digit code on the back AMEX: 4-­‐digit code on the front CID # Billing Zip Code Card Holder’s Signature Amount to be Charged $ JSA Summer School 1411 K St. NW, Suite 200 Washington, DC 20005 United States By Email By Mail By Fax (please bring originals on Opening Day) (please bring originals on Opening Day) summerprograms@jsa.org 2015 JSA DIPLOMAT PROGRAM ORIENTATION GUIDE (202) 296-­‐7839 22 Medical Infor mation For m, par t 1
This form should be filled out by the parent/guardian and returned to JSA by May 1, 2015. Student Information Student Name Campus Address City, State, Zip Father/Guardian Mother/Guardian Daytime Phone Daytime Phone Evening Phone Evening Phone Cell Phone Cell Phone Email Email First Emergency Contact (other than guardian) Second Emergency Contact (other than guardian) Relationship to Student Relationship to Student Daytime Phone Daytime Phone Evening Phone Evening Phone Cell Phone Cell Phone Medical Insurance All students must bring to campus a photocopy of both sides of your insurance and pharmacy cards (front and back) Medical Insurance Provider Policy/Group No. Address of Insurance Company Name of Policy Holder Date of Birth of Policy Holder Employer of Policy Holder Prescription Card No. Medications You Will Have On Campus (Please note that the Junior Statesmen Staff will only administer Advil or Tylenol and no other medications. If your child is prone to stomach aches, colds and cough-­‐ ing, it is your responsibility to pack whatever over-­‐the-­‐counter medications they might require. Also, the Junior Statesmen Foundation staff will not be responsible for administering necessary prescription medications to your child.) My child does NOT take regular prescription medication at this time. My child DOES take regular prescription medication at this time. Medication Name Medication Name Medication Name Return this form WITH the next page to: By Email By Mail JSA Summer School 1411 K St. NW, Suite 200 Washington, DC 20005 United States Medication Name By Fax (please bring originals on Opening Day) (please bring originals on Opening Day) summerprograms@jsa.org 2015 JSA DIPLOMAT PROGRAM ORIENTATION GUIDE (202) 296-­‐7839 23 Medical Infor mation For m, par t 2
This form should be filled out by the parent/guardian and returned to JSA by May 1, 2015. Allergies Do not give my child the following medications under any circumstances: My child is allergic to the following medications, food, insect bites, etc. Does your child carry an EpiPen for allergies? Yes No Medical History My son/daughter has the following health problems/special needs of which you should be aware: Does your child have a history of operation or serious illness? Is your child under the care of a psychologist, psychiatrist or counselor? If so, please provide relevant details. Include additional documents if necessary. Is there anything else that we should know about your child’s physical or mental state? I signify this medical information is true to the best of my knowledge Date Return this form WITH the previous page to: By Email By Mail JSA Summer School 1411 K St. NW, Suite 200 Washington, DC 20005 United States Parent/Guardian Signature By Fax (please bring originals on Opening Day) (please bring originals on Opening Day) summerprograms@jsa.org 2015 JSA DIPLOMAT PROGRAM ORIENTATION GUIDE (202) 296-­‐7839 24 Physician’s Signatur e For m
This form should be returned to JSA by May 1, 2015. To be Completed by Parent/Guardian Campus Student Name Medical History Date of Physical Exam (must be within the last 2 years) Should JSA be aware of any disabilities, dietary restrictions, or mental or physical health issues which the student may have? Yes Describe No Are there any physical activities from which the student should be restricted from participating? Yes No Describe Is the student taking any medications? Describe Immunizations: Please attach a separate sheet with all immunizations or provide dates for the shots listed below. DPT MMR 1st 1st 2nd 2nd 3rd 4th Polio 1st 2nd 3rd 4th Date of last tetanus booster Meningococcus (not required) Hepatitis B (not required) Haemophilus Influenza Type B (not required) Tuberculosis skin test (required for students traveling from outside the U.S.) If positive, can this person participate in the program and not be a danger to himself or others? Yes No Varicella (chicken pox) (not required) PHYSICIAN’S STATEMENT To the best of my knowledge, the student is in good mental and physical health, is up to date with required immunizations and should be able to complete and participate in casual recreation-­‐ al activities in a Junior Statesmen program, unless otherwise noted on this form. Date Physician’s Signature/Stamp Return this form to: By Email By Mail JSA Summer School 1411 K St. NW, Suite 200 Washington, DC 20005 United States Physician’s Name, Address and Phone Number By Fax (please bring originals on Opening Day) (please bring originals on Opening Day) summerprograms@jsa.org 2015 JSA DIPLOMAT PROGRAM ORIENTATION GUIDE (202) 296-­‐7839 25 Air Tr avel Ar rival/Depar tur e Infor mation For m
Please complete the applicable sections of this form and return it to CET by May 1, 2015 Participant Information Your name as shown on your passport: Your cell phone number: Date of birth: Parent/Guardian name: Parent’s cell phone number: If you are not participating in the Pre-­‐Departure Orientation in Seattle, Washington, please complete the following: Arrival Information FOR BEIJING, CHINA on June 26, 2015 Please list below your itinerary from your home to Beijing, China on June 25, 2015, including all the separate flights or legs of your trip. You should plan to arrive at Beijing’s PEK Airport by 3:00 p.m. on Friday, June 26, 2015. Airline & fight number Departure airport & departure time Date Arrival time at PEK CET Academic Program and JSA Diplomat Staff will meet you at the Starbucks Coffee shop in the Arrivals Hall. Please look for the JSA Diplomat signs. Departure information from PEK to your home airport on July 19, 2015 (or July 22, 2015 if participating in the Shanghai extension) Please list below your itinerary from the end of the JSA Diplomat Program on Sunday, July 19, 2015 (or Wednesday, July 22, 2015, if participating in the Shanghai extension), including all the separate flights or legs of your trip, to your arrival at home. Flights should not depart PEK before 12 noon. Date Airline & fight number Departure time from PEK Arrival airport & arrival time Return this form to:
JSA Summer School 1411 K St. NW, Suite 200 Washington, DC 20005 United States By Email By Mail By Fax (please bring originals on Opening Day) (please bring originals on Opening Day) summerprograms@jsa.org 2015 JSA DIPLOMAT PROGRAM ORIENTATION GUIDE (202) 296-­‐7839 26 Visa Information for JSA - Processing a Visa through CIBT Visa information for students processing a Chinese tourist visa through the CIBT Visa Processing Service Please read this entire document very carefully. It includes detailed instructions on how to proceed with the CIBT on-­‐ line visa processing service as well as step-­‐by-­‐step instructions for filling out the Chinese visa application. To prevent any delays in processing your visa, please make sure that you have completed all of the necessary steps to complete your visa application. Tourist visa applications require proof of housing in China (provided by CET via email in the months before the pro-­‐ gram) and a round trip flight itinerary showing entry and exit into Mainland China. Please also include any domestic segments from your state of residence if you are connecting within the US prior to your flight to Mainland China. If you do not have either of these required materials, please contact CET before completing your application including any expediting fees and special services. Students are responsible for additional costs including any expediting fees, special services and shipping of documents to and from CIBT. Please carefully read through the CIBT-­‐generated visa packet for details on additional materials you will need to sub-­‐ mit. If you already have a visa provided by another organization that will be valid for the duration of your CET pro-­‐ gram, please contact us with your specific circumstances before proceeding with the CIBT visa service. If you are unable to use the CIBT visa service to process your visa, please contact CET at meagans@academic-­‐travel.com before proceeding. Costs of the CIBT processing service: Chinese visa: $140 (sometimes less for non-­‐U.S. citizens) – this cost is covered by CET CIBT Service charges -­‐ $58 – this cost is covered by CET Students are responsible for additional costs, including expediting fees and shipping documents to and from CIBT. Visit the following website to access the CIBT online service: www.cibtvisas.com/cetjsa For students who are U.S. citizens: I hold a passport from – select “United States of America” State of residence – select state of official residence or where you currently reside I am traveling to – select “China” I am traveling for – select “ Tourist” Click “Submit” For Students who are NOT U.S. Citizens: I hold a passport from – select your country State of residence – select the state or province where you currently reside I am traveling to – select “China” I am traveling for – select “ Tourist” Click “Submit” *Important: If you are directed to a page where it instructs you to submit a “research request” for your specific country of citizenship, please proceed to fill out all of the information required and submit this to CIBT. It is important that you do this immediately as processing this information may take additional time. Also, CIBT may not be able to process visas for certain non-­‐U.S. citizenships. For all students: How long do you need your visa to be valid? – select ‘Valid for 6 months’ if you have 18 months of validity from your exit to China, you may select “Valid for one year”. The duration of your visa and number of entries is ultimately the decision of the Chinese consulate. You will be directed to a page that will contain detailed instructions on what materials you will need to send in to CIBT. Please note that students are responsible for the cost of shipping to and from CIBT. Please read these instructions very carefully, as any missing materials or information will delay the visa process. Once you have finished reviewing the information on this page, click “Continue” when you are ready to start the visa request process. From this point, you will be guided by CIBT instructions. If you wish to start the online process later and want to review the instructions, or wish to send in a paper application, please click on “Email Application Kit” at the bottom of the page and a PDF copy of instructions and the application will be emailed to your address. When completing the CIBT packet, please use the instructions below to fill out the visa application. NOTE: Photocopies of your passport bio page and Chinese visa are due to CET on May 15th, 2015.
2015 JSA DIPLOMAT PROGRAM ORIENTATION GUIDE 27 Contact Information If after reading through these instructions and you still have questions pertaining to the visa process, please first contact: CET -­‐ Meagan Seitz-­‐Smith: 202.349.7342, meagans@academic-­‐travel.com CIBT visas -­‐ 800.577.2428 -­‐ Please identify yourself with account number 57927 when calling. Visa advisors are available Monday through Friday from 8:30 a.m. 9:00pm Eastern Time. 2015 JSA DIPLOMAT PROGRAM ORIENTATION GUIDE 28