University of Arkansas at Little Rock

Program Name *

Program Leader

Last Name *

First Name *

Department *

College *

Office Phone *

Home Phone *

Email *

Program Associate (if applicable) (Co-leader of Trip)

Last Name

First Name

Department

College

Office Phone

Home Phone

Email

Proposed Destination

Country/Countries *

City/Cities *

Duration/Dates

Program Session *
Fall Semester Winter Break Spring Semester Spring Break Summer I Summer II

Approximate Dates of Travel *

Brief Program Description

A succinct description of the program which should include academic goals and objectives, integration of site to learning objectives, and your personal reasons for directing the program. Explain the course content for each proposed course and rationale for linking course content to the site abroad. *

Proposed course(s) to be taught

Course Title *

Credit Hours *

Course Number *

Instructors *

Are you planning to enroll students in a host foreign institution on site? *
Yes No

If yes, name of host institution

Does the host institution have an agreement with UALR?
Yes No

Will you use a vendor to facilitate in-country logistics? *
Yes No

If yes, please provide the name of the vendor

Are there any prerequisites to be met to participate in the program? *
Yes No

If yes, please list the course prerequisites

Is there a language requirement? *
Yes No

If yes, what language?

Is there a research component? *
Yes No

Is there a Community Service Component? *
Yes No

Is there a Service-Learning Component? *
Yes No

For Repeat Program Proposals Only

The courses offered were approved in previous proposal documents.
Yes No

The 2011 program offers new courses approved by the Department Chair.
Yes No

Program Leader Qualifications

Describe your personal international travel experience, in general, and specifically your international travel and teaching experience with student groups. *

Describe your travel experience in the proposed program location(s). *

If you have not traveled to the proposed host country, how do you plan to acquire information and ideas to maximize the potential for preparing the course material in the foreign country?

Program Associate Qualifications (if applicable)

Safety

I have checked the U.S. Department of State’s website section “International Travel” for security/safety concerns regarding the proposed destinations(s) at the web address http://travel.state.gov
Yes No

Is any program location under a State Department Warning?
Yes No
Does the host country have a visa requirement? *
Yes No