APPLICANT :

Give this form and all materials you have about the program to your study abroad advisor, dean, or other school official in charge of study abroad. Your school official’s signature on this form ensures that work completed on YEHS Study Abroad will be reviewed by your university for transfer credit. It is your responsibility to ensure this form is filled out completely and accurately. Please return this form with your completed application.

Name (please print) ________________________________________________

Country/program ________________________________________________________________ _ Spring _ Fall _ Summer 20 ______

I authorize the YEHS and my home institution to release my educational records to each other. Credits earned at the YEHS are transferable only at the discretion of the receiving school.

Signature of student __________________________________________________ Date ____________________________________________________________

YEHS should send transcript and related materials to: (This is usually your College Registrar or Study Abroad Office.)

Name_____________________________________________________________ School__________________________________________________________

Address ____________________________________________________________________________________________________________________________

City/state/postal code __________________________________________________________________________________________________________________

STUDY ABROAD PROFESSIONAL OR DEAN:

This student has applied to the YEHS Study Abroad program indicated, offered by YEHS in accordance with the Yunnan Provincial Traditional Chinese Medicine Hospital, affiliated with the Yunnan Traditional Chinese Medicine University, accredited by the Ministry of Education of The People's Republic of China,. YEHS has a rolling admissions policy, and many programs fill before the deadlines. This candidate’s application cannot be completely reviewed until we receive this form.

YEHS will grant credit upon successful completion of the program. Please see the YEHS Web site homepage for credit distribution by course. The

above-named student’s application has the approval of this institution. Following his or her return, and upon receipt of the YEHS transcript, the credits

earned will be evaluated and considered for transfer credit and/or toward the fulfillment of graduation requirements at this institution in the following

manner:

Course Possible number of credits Comments

Language Study __________________ ____________________________________________________________________

Thematic Seminar __________________ ____________________________________________________________________

[Environmental] Field Study Seminar __________________ ____________________________________________________________________

Independent Study Project __________________ ____________________________________________________________________

_ Transfer credit will be evaluated upon return.

To the best of your knowledge, has this student ever been on academic or disciplinary probation? _ Yes _ No

_ I have verified the institutional address above where the transcript should be sent.

Please feel free to make comments pertaining to this student’s application on the reverse side of this form.

Name and title ______________________________________________________________________________________________________________________

Name of institution __________________________________________________ Department ______________________________________________________

Telephone __________________________________________________________ Email __________________________________________________________

Signature __________________________________________________________ Fax ____________________________________________________________

YEHS will provide your institution with a transcript with letter grades and a narrative evaluation for the Independent Study

Project, when applicable.

This form should be returned to the student to be submitted with the rest of the completed application.

If you need to send it separately, please mail or fax it to the following address; or you can email it to

YEHS
P.O. Box 269
Denver, CO 80201-0269                                                                                                                                                                                                         Toll free, 1-800-438-2698                                                                                                                                                                                                                                                                          info@yunnanclinic.com • www.yunnanclinic.com