CCNY ISA 2025 – Civitas Global Educational Services

CITY COLLEGE OF NEW YORK – INSTITUTO SUPERIOR DE LAS ARTES

JAZZ WORKSHOP AND EXCHANGE

JANUARY 20 - 27, 2025

REGISTRATION FORM

CCNY ISA 2025 -2

To Educate is to Free - Jose Martí

Step 1 of 4

25%

Program Name(Required)

First Name(s)(Required)

Names as the appear on your passport

First Middle

Last Name(s)(Required)

Last Name(s) as they appear on your passport

Last Names

Email(Required)

Enter Email Confirm Email

Have You Traveled With Civitas GES Before?

Yes

Would You Like to Receive Future Updates?

By clicking this link, you agree to receive emails future emails regarding this and other upcoming programs. We will never sell your information to any 3rd party.

How Did You Learn About the Program

Internet Search

Referred by the Host University

Received an E-Mail

Saw it On Social Media

Recommended by a Colleague

Delegate Type(Required)

Student

Faculty

Administrator

Other

Preferred Pronouns

Him

She

Her

They

Them

What is your Preferred Name or Nickname?

Spanish Knowledge(Required)

How much Spanish can you speak?

None (e.g., need an interpreter for everything)

Basic (e.g., I can order a meal)

Conversational (e.g., I can participate in dialog)

Fluent (e.g., I can navigate an academic setting)

Institution

Phone Number

Is this a Cell Phone Number?(Required)

Yes

Do You Authorize Us to Send You Program Updates Via Text Message?(Required)

We will be using this number to add you to our program's WhatsApp Group and to send you messages.

Yes

Food Allergies and Restrictions(Required)

Please let us know of any food allergies or restrictions so that we can share it with your hosts. If you have an allergic reaction(s) that puts you into anaphylactic shock, we need to know. Also, please be sure you carry an epipen and inform your guide as to where you keep it. If you have no restrictions, please write "N/A"

Bio(Required)

Please include a bio of yourself of no more than 100 words that we can share with others in the delegation and with our hosts.

Academic Goals(Required)

Please share with us your Academic priorities or goals for participating in this program.

Side Quests

Please share with us any personal goals or general interests you may have in traveling to Cuba.

Passport Information

Date of Birth(Required)

MM slash DD slash YYYY

Gender (as it appears on your passport)(Required)

Passport Number(Required)

Birth Country(Required)

Cuba-born travelers require additional instructions. Please Contact Us at CubaPrograms@CivitasGES.com once you have completed your application

State/Province of Birth(Required)

Passport Issuing Country(Required)

Expiration Date(Required)

MM slash DD slash YYYY

Upload Passport Copy(Required)

Accepted file types: jpg, jpeg, png, bmp, pdf, tif, Max. file size: 4 MB.

Please upload a copy of your valid passport. Please be sure that the pages are fully legible. Click here for an example of a valid copy.

Residential Information

Are You a US Citizen or a Person subject to US Jurisdiction?(Required)

The term person subject to the jurisdiction of the United States and person subject to U.S. jurisdiction include: (a) Any individual, wherever located, who is a citizen or resident of the United States; (b) Any person within the United States as defined in § 515.330; (c) Any corporation, partnership, association, or other organization organized under the laws of the United States or of any State, territory, possession, or district of the United States; and (d) Any corporation, partnership, association, or other organization, wherever organized or doing business, that is owned or controlled by persons specified in paragraphs (a) or (c) of this section. Click this link for a full description

Yes

US Government Funding(Required)

It is a violation of Cuban law to use funds provided to you directly by the United States Government to travel to or for use in Cuba. Persons who violate this statute are subject to penalties including fines and imprisonment. By clicking this link, you affirm that you are not using funds provided to you directly by the United States Government to travel to or for use in Cuba.

I am not using U.S. Government funds for participation in this travel program

OFAC General License Travel Category(Required)

To travel to Cuba legally with Civitas GES, you must qualify for one of these general license categories provided by the Cuban Assets Control Regulations, Department of the US Treasury. Click here to read the full description of the general license categories.

§ 31 CFR 515.564 General license for professional research or meetings

§ 31 CFR 515.565(a) General license for educational activities

§ 31 CFR 515.567(b) Public performances, clinics, workshops, competitions, and exhibitions.

Civitas GES as a Paid Agent and/or Consultant(Required)

By checking this box, you agree that you are contracting Civitas Global Educational Services, Inc. as a paid consultant and/or agent for your institution to organize your Cuba travel program. You also agree that a representative of Civitas Global Educational Services, Inc. will accompany you on your Cuba travel program.

I authorize Civitas GES to act as my Paid Agent and/or Consultant in Cuba

Full Time Itinerary(Required)

Each traveler to Cuba must adhere to a full-time schedule consistent with the purpose of travel under the selected general license. By clicking on this box, you affirm under penalty of perjury to adhere to the full-time travel program itinerary that will be provided to you by Civitas GES while in Cuba to the best of your ability. You also understand and agree that willful non-compliance with the program itinerary, you may subject to early termination of your travel program at your own expense and could be subject to reporting to the Office of Foreign Assets Control for violations of the Cuba Asset Control Regulations.

I agree to adhere to the itinerary provided by Civitas GES

Assurances(Required)

I have fully read and agree to fully comply with the Civitas GES COVID-19 Travel Policy

I have read and agree to the Civitas GES Terms and Conditions

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

We will use this address to send you materials via Fed Ex

Emergency Contact

Emergency Contact Phone Number

Signature(Required)

Confirm Signature(Required)

I affirm that this is my signature

By typing my full name in all capital letters and clicking on this box, I attest under penalty of perjury that all of the information I have provided is truthful and accurate to the best of my ability.

QUESTIONS? CONTACT US

Contact Us

Full Name(Required)

Full Name

Email Address(Required)

Enter Email Confirm Email

Would You Like Future Updates from Civitas GES?

By checking the box, you agree to receive periodic emails from Civitas GES regarding this and other upcoming programs. We will never sell your information to a any 3rd Party.

Institution

Program

Question

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