Program Provider Application : Education Abroad : Texas State University

Name of provider: *

Website: *

Address: *

Email address *

Phone number: *

Contact person: *

Brief history: *

Provider's area of expertise/specialization: *

Countries/state/cities where services are available: *

Accreditations, recognitions, etc..: *

Description of services to be provided: *

Description of 24/7 services available: *

In-country resources: *

Are you able to provide customized virtual programs? *

Yes

No

Explain: *

Description of your facilities (headquarters, permanent buildings on-site, etc.): *

Please upload photos of your headquarters, permanent buildings on-site, etc. (photo 1) *

Please upload photos of your headquarters, permanent buildings on-site, etc. (photo 2) *

Please upload photos of your headquarters, permanent buildings on-site, etc. (photo 3) *

Number of staff members: *

English *

Yes

No

Local language *

Yes

No

N/A

Years (staff) living in onsite location: *

Staff certifications: *

Staff training programs: *

Years of experience: *

Additional comments about your staff:

Describe your local network support system: *

Are you able to offer special accommodations to serve students with disabilities at your locations?

Yes

No

Explain: *

Description for screening families: *

Do you perform background checks? *

Yes

No

Explain: *

How do you communicate expectations and conduct rules to participants? *

If providing charter buses and/or drivers, how do you adhere to strict safety standards? *

List of institutions (including contact information) you are currently working with or have worked with in the past. *

Letter of recommendation #1 *

Letter of recommendation #2 *

Letter of recommendation #3 *

Copy of your emergency action plan/protocols. *

Description of on-site orientation for students (copy of full agenda if available). *

Copy of proof of insurance (property damage and injuries, liability, etc.). *

Copy of all applications, contracts, and participants waivers that you require students and/or faculty to sign. *

Additional Comments:

Program Provider Application

For customized programs only (global and domestic)