Year in Munich Confirmation Form

In order to confirm your participation in the Lewis & Clark Year in Munich program, you must complete this confirmation form. Please answer the questions thoroughly. The Overseas & Off-Campus Programs Office will review your form with care, and use the information you disclose to advocate for dietary, academic, and medical accommodations for you while you are on your program

Decision Confirmation

Academic Accommodations

Overseas & Off-Campus Programs is committed to providing students with the most successful experience possible. If you have a disability for which you'll be requesting accommodations, please request that Student Support Services send us your Accommodations Letter by selecting "yes" below.  Once we have this information, together we can facilitate accommodations you might need while overseas.  Please be aware that many other countries do not have accessibility standards that meet the Americans with Disabilities Act requirements developed for the United States. As a result, the College cannot ensure that all students with disabilities can be accommodated on all of our overseas programs. When a student's needs cannot be accommodated in a particular activity or program, staff will explore with the student whether potential alternative educational experiences or programs are available. Unless you indicate that you would like accommodations abroad, we will not request any information from Student Support Services on your behalf.
I would like Overseas & Off-Campus Programs to request my Accommodations Letter from Student Support Services.

Medical History

Overseas & Off-Campus Programs may consult with campus partners such as the Welfare Intervention Network to evaluate safety concerns.

If any of the questions below do not apply to you, simply type n/a into the response field.

It's very important to consider what medications you will need to have on hand while you are overseas. Many countries have restrictions on what medications you are allowed to bring in or have refilled while in-country. If you plan to take any sort of prescription medication while on your program, please let us know in this form so that we can work on a plan to make sure you have access to necessary medication for the duration of your program.

If you plan to discontinue the use of any medications for the duration of your program, be sure to talk with a medical care provider about the potential risks.

Please indicate the most recent date (month, day, year) you have had the following immunizations.  If you are missing one, please indicate when you plan to receive the immunization:

Health Insurance Verification

Please provide the following information about your insurance provider to verify that you have adequate coverage during your participation in the Year in Munich program. Keep in mind that all Lewis & Clark undergraduate students -- both those studying in Portland and those participating in overseas programs -- are automatically enrolled in and billed for the College's student health insurance program for the full year, starting in the fall semester, unless they waive their enrollment in that program.


The Office of Overseas and Off-Campus programs will consult with the Office of Student Rights and Responsibilities, the Office of the Dean of the College, and other campus offices as appropriate to ensure students' eligibility to participate.


FERPA protects the rights of students by guaranteeing access to their educational records while prohibiting unauthorized access by others. This form is optional.

Should you wish someone to receive information about you, your program, your academic progress, your financial situation, etc. while you are gone, you should designate someone on this form. Without this official designation, we will not share any personal information about you or your program with any outside party.

I authorize the Lewis & Clark Overseas & Off-Campus Programs Office to release information concerning my account (billing, payments, financial aid distributions) and/or other items related to my overseas program by phone or mail to the following people:

Photo Model Release Form

Lewis & Clark Photo Model Release Form:

The undersigned agrees to participate in photography for promoting the work of Lewis & Clark (Lewis & Clark College, Lewis & Clark Graduate School of Education and Counseling, Lewis & Clark Law School). The undersigned hereby authorizes the use and reproduction by Lewis & Clark College, or anyone authorized by the College, of any and all photographs or other images taken of the undersigned, for purposes deemed appropriate by the College without compensation. The undersigned understands that these images may appear in any of the wide variety of formats and media now available to the College or that may be available in the future, including but not limited to print, electronic/online media, and video. The undersigned acknowledges that all images are the property of Lewis & Clark College.

Final Comments