Faculty Exchange Form

Please note: You must have approval from your supervisor. By completing this form, you understand that although the trip is paid for, a salary is not paid for participation. Also, you are responsible for obtaining a passport (approximately $135), ensuring health insurance and a valid credit card, and covering your personal expenses on the trip which include meals, shopping, and a gift for your host.

Gender
Address
Do you have a criminal record or any pending charges?
Have you been in any formal disciplinary action while employed by Mid-State Technical College?
By accepting below I attest to the accuracy and honesty of the responses I provided to each of the questions above. Should any of this information change prior to travel, I am required to notify the Student Life Manager immediately.