Application to Print and Mail or Fax

This form is for you to complete, print, and mail, email or fax along with your credit card (Visa) information or check. If you prefer to apply via an online form submission with immediate payment with your credit card through PayPal, please use this electronic application form

To Email Form: Print/Sign/Scan form and email to: sws@signatureservices.com
To Fax Form: Print/Sign/Fax form to: 214-353-4954
To Mail Form: Print/Sign/Mail form to:
Signature World Services
PO Box 35885
Dallas, TX 75235

Personal Information

 
Name:             Last First Middle:
 Current Email: Primary Phone:
Additional Phone: Date of Birth:
Current Address: Permanent Address:
Social Security Number: Place of Birth:
       

Gender: Male Female Country of Citizenship:
Passport Number:  
If you do not have a current passport, please apply for one IMMEDIATELY
Emergency Contact:   Email:
   
Relationship: Mother Father Other (specify)
 

Current Academic Information


Home Institution:   State:
   
Major/Minor: Classification: Freshmen  Cumulative GPA (4.0 scale):



Transcript Release Information

One official and one unofficial copy of your transcript* are included in the program price.
I authorize SWS to mail my official transcript(s) to my home institution as indicated this application.
I will submit a Transcript Request Form to SWS indicating where to send my official transcript
I understand that SWS will keep my official transcript on file until the request is submitted
*Foreign transcripts may take up to 90 days to be received.

Financial Information

What is your plan on financing your study abroad program?
Self Parents Scholarship from Home Institution Financial Aid from Home Institution
Private Loan Other Source:
SWS will include account statements to the address provided.

Payment Due Dates


Term 1st Installment 2nd Installment Final Installment
Fall June 1 July 1 August 1
Spring October 1 (previous year) November 1 (previous year) December 1 (previous year)
Summer February 1 March 1 April 1

Refund and Cancellation Policy

No application fees or deposit monies will be refunded at any time to the applicant, parent, guardian, or payor. A cancellation or withdrawal
from any program must be received in writing from the applicant 30 days prior to the final payment due date stated above in this agreement.
If the applicant’s cancellation or withdrawal is properly received prior to 30 days from the final payment due date, SWS will refund up to
50% of all payments received, excluding application fees and deposit monies, which are non-refundable.

Payment Information

If you have a promotional code, enter it here:
Payment Amount: (check all that apply)
$65 Non-Refundable Application Fee
$475 Non-Refundable Confirmation Deposit (semester programs only)
$250 Non-Refundable Confirmation Deposit (summer programs only).
Total Amount:

If paying by credit card, please include the following:
VISA Card Number: 
Expiration: 
Billing Address: 
Cardholder Name: 
Cardholder Signature: 

Check Box Above if Sending Payment Electronically
If making payment by check/money order, mail payment to: Signature World Services
PO Box 35885
Dallas, TX, 75235

Agreement and Release


receipt and sufficiency of which is hereby acknowledged, the parties hereby agree as follows:

Signature Services dba SIGNATURE WORLD SERVICES (SWS), will provide study abroad opportunities to the party first acknowledged
above upon the fully approved signed application above and signed by SWS, its agent or assigns.

Upon approval of the application, the applicant agrees to pay the full sum for services rendered by SWS under the terms and conditions
agreed to by both parties. The approved applicant and undersigned (or parent / guardian, if a minor) fully and completely consent to the
acknowledgements and release stated below:

ACKNOWLEDGEMENTS, CONDITIONS and RELEASE

1. I understand that my participation in a study abroad program (“Program”) organized by Signature Services Corporation
(dba, Signature World Services “SWS”), a Texas corporation, is contingent on SWS’s review and acceptance of my SWS Application
(“Application”).

2. I acknowledge that I have read and accept the terms and conditions set forth in SWS’s Polices and or Conditions available on SWS’s
website at www.AbroadWithSWS.com, which are incorporated herein by reference and which constitute part of this Application. This
agreement is a legally binding contract. I agree that, if I am accepted as a participant in the program for which I am applying to, that I am
responsible for full payment of all programs and fees; and I further agree to make prompt, timely, and full payments as specified by SWS.
I give full consent to SWS for the use of my name, picture, photograph, or statements for publicity or marketing purposes.

3. I acknowledge that I may engage in activities that involve risk of loss of property, personal injury, illness or death. I hereby assume all of
the foregoing risks and I release, waive, discharge and agree to hold harmless SWS and its officers, directors, employees and agents from any
loss or liability in any way relating thereto. I unconditionally release SWS from any claims for damage, injury, loss or expense of any nature
resulting from events beyond its control, including but not limited to acts of God, war, strikes, crime, terrorism, sickness, or quarantine,
government restrictions or regulations. This release also applies to any losses arising from the use of any vehicle or from the selection of, or
from any act or omission by, any housing agency, host family, travel agency, transportation provider, hotel or excursion provider, host
institution, company or individual.

4. I understand that I will be traveling to a foreign country, with different customs, standards, laws and risks than I am unaccustomed to. I
understand and acknowledge that (a) I may become sick or injured while participating in a Program; (b) I may be arrested or imprisoned if
I do not conform to local laws; (c) there exists crime in foreign countries and that I may be a victim of crime; and (d) I may not agree with
local customs and standards. I accept the above-described risks and other risks associated with travel in, to and among foreign countries. I
understand that I am responsible for exercising caution and common sense at all times and that SWS is not responsible for my safety or acts
of third parties, and I agree to release and not hold SWS responsible for any such problems I encounter in a Program.

5. I understand that as a Participant in the Program, I will be residing in housing arranged by SWS. I also understand that during the Program
orientation, housing practices will be explained to me and a housing contract will be presented. I unconditionally agree to abide by the
terms of this Agreement, its Conditions, and Release as well as any additional agreements or contracts required during the pendency of the
program. In particular, and with respect to housing, I acknowledge and understand that I am solely responsible for my own possessions
and safety of those possessions and, that SWS is not responsible for theft or burglary of my possessions, nor is SWS responsible for lost
or misplaced possessions of mine at any time. I also acknowledge that it is my sole responsibility, relating to my personal possessions,
that I inquire from my insurance company, whether any particular property or rental insurance policy I maintain or that are maintained for
me, cover my possessions, will be valid in the location of my study abroad program, and if not, that if I wish for my possessions to be
insured, that it is my sole responsibility to deal with insurance providers who will cover my possessions in the location of my study abroad
program, and it is my sole responsibility to understand, make available, or obtain coverage for my personal possessions in the location of
my study abroad program.

6. If I become sick, injured, or incapacitated in any way while participating in the Program, I authorize SWS to take such action as it considers
necessary to secure treatment and/or transportation back to the United States assuming there is no written or verbal prior instruction
from a parent or guardian. I release SWS from any liability relating to this medical care. I agree to provide the name of an Emergency Contact
whom SWS may contact should SWS deem it necessary. If SWS incurs and expense on my behalf that is not covered by insurance, I agree to
make immediate repayment upon my return. I hereby acknowledge that this Application does not create any affirmative duty or respons-
ibility for SWS to take any action should I become sick or injured while participating in a Program.

7. I also authorize release to SWS, through my signature below, protected health and mental health records, such release expiring on
completion of the Program. By signing below and providing this release, I understand that:
• I can revoke this Authorization at any time by giving my written revocation to the Disclosing Provider/Covered Entity. My revocation is
not effective as to disclosures already made and actions already taken in reliance upon this Authorization.
• I can refuse to sign this Authorization, and the disclosing provider/plan may NOT condition treatment, enrollment in the health plan or
eligibility for benefits on whether I sign this Authorization.
• I am authorizing disclosure of information protected under federal law. This information, once disclosed, may be subject to re-disclosure by
the recipient and may no longer be protected by state and federal law.
• I may ask the provider/covered entity for a copy of the protected health information being disclosed under this Authorization.
• I will be provided with a signed copy of this Authorization.
• A photostatic copy of this document shall have the same effect as the original of same. Authorization to release health and mental health
records does not create an affirmative duty or obligation for SWS to do a background check of Applicant as Applicant remains obligated to
be honest and forthright, and not omit or misrepresent information requested. SWS reserves the right to obtain records pursuant to this
release, within the applicable period, in the event of ambiguity of information, disputes or unanticipated or unusual conduct exhibited during
the Program.

8. I will comply with all SWS’s Policies, including its rules, standards, instructions and practices for program participation behavior, including
housing. I understand that failure to do so may result in disciplinary action up to and including dismissal from the Program. If dismissed, I
understand that (a) the cost of returning home is my own expense, and (b) I will not receive a refund of any kind. I understand that my
participation may be terminated if I am expelled from school, deemed academically ineligible by the school, or otherwise disciplined by
school or civil authorities, or if SWS, in its sole discretion, determines that my conduct is incompatible with the safety or welfare of other
participants and/or myself, or, in any way undermines the Program. I agree to indemnify SWS if I do anything that causes SWS to sustain
financial loss or liability.

9. I understand that SWS requires all participants to be enrolled in a current insurance plan that will cover them while they are abroad. The applicant must show sufficient health, medical and accident insurance to SWS once they are accepted into the program. I acknowledge that it is my responsibility to understand the limitations of the coverage and agree that SWS is not responsible for any losses, accidents or illnesses.

10. I understand that SWS reserves the absolute right to reject my application or dismiss me from a Program if, after acceptance, SWS learns
of a condition (personal, medical, academic and/or psychological) which in the reasonable opinion of SWS may endanger me or others,
and/or puts me at risk in a foreign country, and/or shows a history of an inability to adapt to challenging situations, and/or creates or re-
quires burdens and resources not required or necessary to maintain other students.

11. I understand that SWS occasionally uses statements made by its students and/or their photographs in marketing materials on the web
and in print. I consent to such use of my statements or photographs of me. I agree that SWS may add my name and email address
to an email distribution list which will be shared by other participants on my Program, unless I notify SWS in writing otherwise.

12. I authorize SWS to release my Application and supporting documentation to my host institution(s), my home institution(s), their
personnel and SWS Staff.

13. I understand that SWS or the sponsoring academic institution reserves the right to make changes, cancellations or substitutions to the
Program for insufficient enrollment, emergency or changed conditions or based upon the interest of the group. I understand that any
expenses incurred due to these changes, cancellations or substitutions are at my expense. If I choose to leave the Program as a result of these
changes, I understand there will be no refund of program fees or of any expenses already paid.

14. I understand that obtaining a passport and any other required travel documents is my sole responsibility. Whether I am a U.S. citizen
or not, I shall hold SWS harmless in the event I cannot or choose not to obtain the necessary documents for participation in the Program.
I understand that the inability to obtain these visas and other documents does not constitute grounds for a refund or waiving any program
fees.

15. Any action or suit brought relating to this Application or my participation in a Program must be commenced and maintained in the ap-
propriate state court of Texas, located in Dallas, Texas. The parties irrevocably consent to jurisdiction and venue in such courts for such
purposes and agree not to seek transfer or removal of any action commenced in any such court, and agree that Texas law applies irrespective
of any conflict of laws analysis. The validity, construction, and enforceability of this Agreement will be governed in all respects by the
State of Texas. In the event either party hereto institutes an action or other proceedings to enforce any rights arising under this Application,
the party prevailing in such action or other proceeding will be paid all reasonable costs and attorney’s fees by the other party. Such fees to
be set by the court and not by a jury and to be included in any judgment or award entered in such proceeding.

16. References in this agreement to “Applicant”, or “I”, shall include the Applicant, any legal guardian or parent of the Applicant, and the
Applicant’s spouse and heirs. References in this Agreement to “SWS” shall include Signature World Services, and its subsidiaries, and all of
its officers, directors, employees, agents, interns, representatives, group leaders and host school officials.

This Agreement embodies the complete agreement of the parties hereto with respect to the subject matter hereof and supersedes any prior
written, or prior or contemporaneous oral understandings or agreements, between the parties that may have related in any way to the
subject matter hereof.

This Agreement may not be amended except by an instrument in writing approved by the parties to
this Agreement and signed on behalf of each of the parties hereto.

Name of Applicant:  
Signature of Applicant:  Date:
Name of Guardian (if app. is under 18):    
Signature of Guardian:  Date:


IMPORTANT: Your application is not complete until the Agreement and Release form is signed and dated.