Customized Program Request Form

Complete the customized request form to tell us more about your program needs and goals, and someone from the LAC Customized team will contact you.

Contact Information

First Name:

Last Name:

Title:

Department:

Email:

Institution or Organization: (you must select an institution from the drop down list)

Can't find my institution/organization selector

Type "Institution or Organization Not Found" in the field above and also enter your institution/organization below so that we can add it to our database. Thank you!

This form consists of the following sections:

Proposed Program Information
On-Site Costs
Program Description

Click 'Continue' to proceed to the next section.

Proposed Program Information:

Program Title:

Program Contact:

Program Leader(s):

Proposed Program Dates:

Minimum number of students:

Maximum number of students:

Program Site:

This program will be open to:

UMTC students

non-UMTC students

UMTC and non-UMTC students

Will students receive credit for this program:

Yes

No

Section I: On-Site Requests

Select all program components you will need for your program. You will be prompted to provide additional details for all items requested.

Services

Classroom space (indicate estimated number of days/hours and type of space needed):

Teaching equipment (indicate type: computer, DVD player, projector, etc.):

Transportation to and from airport to housing accommodations:

Transportation for field trips/day excursions:

Local transportation pass:

On-site orientation on health, safety, logistics, etc.:

Neighborhood tour/sightseeing tour of city:

Survival language course (indicate number of days/hours):

Program leader local cell phone or SIM card:

24-hour on-site emergency contact and support (automatically provided):

Accommodation (indicate number of nights)

Program leader housing:

Student housing:

Meals

Welcome luncheon/dinner/reception:

Farewell luncheon/dinner/reception:

Meals (indicate number of additional meals)

Activities/Site Visits/Excursions

List below and specify when a guided tour is preferred, if known:

Guest Lectures

List guest lecture topic(s):

Section II: On-Site Costs

Round trip international airfare included?

Yes

No

In-country airfare included?

Yes

No

Will there be more than one program leader?

Yes

No

Pricing structure for multiple program leaders:

Separate out program leader costs

Amortize program leader costs

Program costs additional information:

Section III: Program Description

Provide additional context about the course in the space below by entering course information or by uploading a syllabus or other document (for example, 1) course designator, 2) course number, 3) course description, 4) ideal itinerary, 5) number of credits, 6) syllabus).

Attach additional documents if needed:

Upload course syllabus or other document here:

Provide any additional information about the program that would be helpful for us to know or requests not yet indicated above, or upload a document with the information below.

Upload additional course information here: