Study Abroad in England 2017 - Commitment Form

Once you are ready to commit to enrolling in MCOM 7001 / COMM 4070 International Communication and Culture, please access, complete and send the form below. When you click on the "send" button, the form will be forwarded to the course leader, Gary Radford.

This is not an enrollment or registration form. Fairleigh Dickinson University student should enroll for the course just as they would any other course, through WebAdvisor or the Office of Enrollment Services. Visiting students from other colleges and universities should print, complete, and return the "Application for Visiting College Students." You can access the form by clicking on the name of the form.

This Commitment Form is necessary for two main reasons: (1) to ensure that all students have medical insurance which covers them while they are abroad, and (2) for the course leader to have a firm knowledge of the number of committed students so the necessary arrangements can be made for accommodation, site-visits, theater tickets, and so on. It also provides the course leader with contact information for committed students.

Contact Information and Insurance Information for Study Abroad Students.

All participants in Fairleigh Dickinson University’s study abroad programs are required to carry insurance which will cover them for illness, accident and for major medical. It is preferred that this insurance also cover them for medical evacuation and repatriation (if you should become ill while abroad, evacuation can cost many thousands of dollars). All participants must complete the form below and return it to the course leader, Gary Radford, with proof of coverage prior to departure. Proof of coverage consists of a copy of the insurance card and a copy of the section of the policy which states that the participant will be covered while outside the continental United States. Many policies do not cover while abroad. If the participant is covered under an employee benefit and a copy of the policy is not available, a letter from the employee’s Human Resource Office can be substituted.

Once proof of insurance has been submitted to the Office of Overseas Programs, the charges for Fairleigh Dickinson University insurance will be waived. If you do not have proof of insurance, the fee will be charged and the Office of Overseas Programs will enroll you with INA, a company with extensive experience in insuring people while traveling abroad. You will receive a card in the mail once you reach your study site.


Commitment Form

My contact information ...

Full Name



Home Address



ZIP/Postal Code

Home Email

Home Phone

Business Phone

Business Fax

My insurance information ...

Insurance Company

Policy Number

Submit the Form



Dr. Gary P. Radford
Department Chair
Tel: 973-443-8648

Department of Communication Studies
Fairleigh Dickinson University
285 Madison Ave - M-ZN2-02
Madison, NJ 07940

Fairleigh Dickinson University Mansion
Office Location
Office 250