YOU MUST PRINT THIS FORM AND SUBMIT IT, ALONG WITH THE APPROPRIATE SIGNATURES, TO YOUR PROGRAM DIRECTOR.
By signing this document you are confirming that you have read, understand and agree to the terms of the Short-Term, Off-Campus Agreement and Waiver.
I have read and understand the above documents and I agree to all terms and conditions of these documents made effective with the date of my signature recorded below.
Students must agree to the terms of these agreements in order to participate on the program.
Applicant’s full name (Print)
(Signature of Applicant/Participant) Date
Parent/Legal Guardian's full name (Print)
(*Signature of Parent/Legal Guardian) Date
(Short-Term, Off-Campus Program) CSB/SJU Banner ID #
*Parent or Guardian signature is necessary unless the student is not considered a dependent for federal income tax or financial aid purposes.