Application/Registration Form

Registration is on-going now. Please complete this form and submit it along with a $395.00 deposit as well all required documents to the address below. Make check or money order payable to CCRI Program in Italy.
Application/Registration Deadline March 31, 2017. Full program payment is due May 5, 2017. Participants may apply after March 31 deadline if space is available.
Please PRINT all information and retain a copy for yourself.


First Name: ______________________________________________
Middle Initial: _____________________________________________
Last Name:_______________________________________________

CCRI ID*:________________________________________________
D.O.B. __________________________________________________

*Your CCRI Banner ID# is the 8-digit number below your name on your CCRI ID. If you are not a CCRI student,  you must fill out a College Registration Form in order to be assigned the CCRI student ID Number.

Home Telephone: _________________________________________
Cell. ___________________________________________________
E-mail:__________________________________________________

Street Address____________________________________________
City: ___________________________________________________
State: _____________ Zip Code: _____________________________

Have you studied Italian? ____________________________________
If so, when?_______________ Where? ________________________ 
Highest level courses taken: __________________________________

Institution attended: ________________________________________ Concentration/Major________________________________________

Special interest: ___________________________________________
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Why do you want to participate in this program?

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_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

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Please indicate your preferences:

___ I am enrolling for credits
___ No Credits/Audit
___ Double occupancy: ___ nonsmoker ____ smoker
___ Single room requested

___ 1 week program (June 21-June 29, 2017)
___ 2 weeks program (June 21-July 06, 2017)
___ 3 weeks program (June 21-July 18, 2017)

___ I am an accompanying participant

Course(s) Preference. I am enrolling in:
(Participants may register for a total of 6 credits)

___ Elementary Italian I (ITAL-1030 -3 credits)
___ Conversational Italian I (ITAL -1510 -3 credits)
___ Italian Heritage (ITAL-1900 -3 credits)
___ Italian Culture-Cuisine (ITAL-1910 -1 credit)
___ Italian for Business & Travel (ITAL-1950 -1 credit)

___ Italian Course(s) not listed above

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___ Copy of Medical Insurance enclosed
___ Photocopy of the photo information page of passport enclosed
___ $395.00 Deposit enclosed
___ Release Form enclosed
(The Release Form will be sent to you upon acceptance in the program)

Please read carefully the following information:

The Summer Program in Italy requires extensive long-term planning and preparation. We encourage participants to enroll as early as possible. Applications will be reviewed in the order received. Notification of acceptance in the program will be communicated by the Program Coordinator/Director.

Final payment is due May 5, 2017. Please make a check payable to CCRI.
► The $395.00 deposit will be applied toward program fee.
► Students enrolled for 3 credits or more must attend the full 3-week program (June 21-July 18, 2017)
► Applicants may be interviewed in addition to completing the application.
► Participants must attend pre-departure informational meetings.
► Participants will be registered for their courses upon acceptance into the program.
► It is the participant's responsibility to pay his/her tuition directly to the CCRI Bursar's Office before departure.
► The CCRI Program in Italy reserves the right to cancel the program prior to departure for insufficient
enrollment or other valid reasons. In the event of cancellation by CCRI, a full program refund will be
provided.
► Participants are strongly recommended to purchase travel insurance when booking their flight.
► If a participant must withdraw from the program, a written cancellation letter, must be received.

The following Cancellation Policy applies. Charges are calculated as the day written notification is received:

☺ 90 days before departure: no refund administrative study abroad fee $180.00.
☺ 60-90 days before departure: no refund $395.00 deposit and administrative fee.
☺ 30-60 days before departure: 25% program cost refund, less deposit and administrative fee.
☻30 days or less before departure, and after the starting of the program in Italy: no refund.

Name (Please print): ________________________________________
Name (Please Sign):_________________________________________

Date:____________________________________________________

Please mail all required documents with a $395.00 deposit to:

Maria C. Mansella, Professor
Community College of Rhode Island
Department of Foreign Languages and Culture
400 East Ave.
Warwick, RI 02886


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Last Updated: 11/30/17