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CFE-INVESTIGATIONS CFE Investigation Certified Fraud Examiner

Exam Detail:
The CFE-INVESTIGATIONS (CFE Investigation Certified Fraud Examiner) exam is a professional certification exam offered by the Association of Certified Fraud Examiners (ACFE). It is designed to assess the knowledge and skills of individuals involved in fraud investigations. Here are the exam details for the CFE-INVESTIGATIONS exam:

- Number of Questions: The exam typically consists of 125 multiple-choice questions.

- Time Limit: The time allocated to complete the exam is 4 hours.

Course Outline:
The CFE-INVESTIGATIONS course provides a comprehensive understanding of various topics related to fraud investigations. The course outline generally includes the following areas:

1. Introduction to Fraud Investigations:
- Understanding fraud investigations and their importance.
- The role of a fraud investigator and their ethical obligations.
- The legal framework for fraud investigations.

2. Fraud Prevention and Deterrence:
- Identifying fraud risk factors and vulnerabilities.
- Developing and implementing effective fraud prevention programs.
- Evaluating and improving internal controls.

3. Financial Transactions and Fraud Schemes:
- Understanding financial transactions and common fraud schemes.
- Recognizing red flags and indicators of fraud.
- Analyzing financial statements and records.

4. Fraud Investigation Process:
- Planning and conducting fraud investigations.
- Gathering evidence and conducting interviews.
- Documenting findings and preparing investigation reports.

5. Legal Considerations and Prosecution:
- Understanding the legal system and the role of the investigator.
- Laws and regulations related to fraud investigations.
- Presenting evidence and supporting prosecution efforts.

6. Data Analysis and Technology in Investigations:
- Using data analysis techniques to detect and investigate fraud.
- Digital evidence collection and analysis.
- Leveraging technology tools for fraud investigations.

Exam Objectives:
The objectives of the CFE-INVESTIGATIONS exam are as follows:

- Assessing candidates' knowledge of fraud investigation principles and techniques.
- Evaluating candidates' understanding of fraud prevention and detection methods.
- Testing candidates' proficiency in conducting fraud investigations and gathering evidence.
- Assessing candidates' knowledge of legal considerations and ethical obligations in fraud investigations.
- Evaluating candidates' understanding of data analysis and technology applications in fraud investigations.

Exam Syllabus:
The specific exam syllabus for the CFE-INVESTIGATIONS exam covers the following topics:

1. Introduction to Fraud Investigations:
- Fraud investigation principles and concepts.
- Ethics and legal considerations in fraud investigations.

2. Fraud Prevention and Deterrence:
- Fraud risk assessment and prevention programs.
- Internal controls and fraud prevention measures.
- Corporate governance and ethics.

3. Financial Transactions and Fraud Schemes:
- Common fraud schemes and red flags.
- Analyzing financial statements and records.
- Fraud risk factors in different industries.

4. Fraud Investigation Process:
- Planning and conducting fraud investigations.
- Evidence gathering and documentation.
- Interviewing techniques and statement analysis.

5. Legal Considerations and Prosecution:
- Legal framework for fraud investigations.
- Laws and regulations related to fraud.
- Presenting evidence and supporting prosecution efforts.

6. Data Analysis and Technology in Investigations:
- Data analysis techniques for fraud detection.
- Digital evidence collection and analysis.
- Technology tools for fraud investigations.
CFE Investigation Certified Fraud Examiner
ACFE Investigation study tips

Other ACFE exams

CFEX Certified Fraud Examiner (CFEX)
CFE-FP-D Fraud Prevention and Deterrence
CFE-FT-FS CFE Financial Transactions and Fraud Schemes Certified Fraud Examiner
CFE-INVESTIGATIONS CFE Investigation Certified Fraud Examiner

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ACFE
CFE-INVESTIGATION
CFE Investigation Certified Fraud Examiner - Investigation
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Question: 52
During an interview, Alex asked a fraud suspect if he could retrieve the suspects account records from her bank. The
suspect said, "yes." but she did not provide consent in writing
Although the suspect orally consented, the suspects bank is NOT required to allow Alex to access the suspects
account records at this point.
A. True
B. False
Answer: A
Question: 53
Tara. a Certified Fraud Examiner (CFE). is searching social media sites for evidence in a fraud investigation .
Which of the following is the MOST ACCURATE statement regarding what Tara should do when mining social
media sites for evidence of fraud?
A. Tara should preserve the information by saving the links of the postings as bookmarks in her browser.
B. Tara should preserve the metadata by printing out the web pages of each of the postings.
C. Tara should conduct a forensic shutdown of the computer to preserve the metadata m the social networking sites.
D. Tara should preserve the information from the sites so that it can be established as authentic if used in court.
Answer: B
Question: 54
Which of the following is NOT one of the main limitations of conducting a search for public records using online
databases?
A. Online public records searches are limited in the jurisdictions they cover.
B. Public records database companies are difficult to find.
C. Online coverage of public records varies widely from jurisdiction to jurisdiction
D. The timeliness and accuracy of information in online databases must be validated
Answer: C
Question: 55
Caroline, a fraud examiner, is conducting an admission-seeking interview with John, an employee suspected of
stealing cash .
Which of the following is the MOST effective phrasing for Caroline to use when posing an admission-seeking
question to John?
A. "Why did you take the money?"
B. "What do you know about the stolen money?"
C. "Do you know who took the money"
D. "Did you steal the money?"
Answer: D
Question: 56
Gunn, a Certified Fraud Examiner (CFE). was hired to trace Kellys financial transactions. During his investigation.
Gunn obtains records of electronic payments that Kelly made during the past three years .
Which of the following are these records MOST LIKELY to reveal?
A. If Kelly has been skimming funds
B. The cities and countries in which Kelly conducts business
C. The division and distribution of Kellys assets
D. The market value of any real property Kelly owns
Answer: C
Question: 57
Orlando is conducting a fraud examination regarding Fast Freight, a large publicly traded corporation, and wants to
find the current officers and directors of the company .
Which of the following would be the best source of information for this purpose?
A. Commercial filings
B. Real property records
C. The companys corporate bylaws
D. Regulatory securities records
Answer: A
Question: 58
Which of the following is the MOST ACCURATE statement regarding the analysis phase in digital forensic
investigations?
A. The analysis phase of digital forensic investigations should not commence unless it is verified that the suspect
devices do not contain relevant data.
B. During the analysis phase, it is best to use a combination of the various forensic tools that can assist h identifying,
extracting, and collecting digital evidence
C. When analyzing data for evidence, fraud examiners should look for exculpatory evidence but not exculpatory
evidence
D. The primary concern when analyzing digital evidence is to protect the collected information from seizure
Answer: B
Question: 59
Anne used Will as a confidential informant in her investigation Anne listed information provided by Will in her final
report, referring to him using his initials. She paid Will in cash and obtained a receipt for the transaction .
Which of Annes methods was NOT considered a best practice when using informants?
A. Referring to Will using his initials
B. Obtaining a receipt from Will
C. Using information provided by Will in her report
D. Using cash to pay Will
Answer: A
Question: 60
Which of the following statements is MOST ACCURATE regarding how a fraud examiner should prepare for an
interview with a subject from a different jurisdiction?
A. Failing to observe cultural norms is not a concern if the interviewer is from a different country than the interviewee.
B. Consulting with legal counsel is only necessary when an investigation spans multiple
C. A fraud examiner should find out whether the interviewee can insist upon the presence of a legal representative
D. A fraud examiner does not need to research cultural considerations such as appropriate greetings and eye contact.
Answer: C
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Is there a daycare in WNY that has you concerned? Is there a child care provider you'd like investigated? Do you want to see your child's daycare recognized for going above and beyond? 7 Eyewitness News anchor Ed Drantch and the I-Team are telling the stories of daycares in your neighborhood-- the good and the bad.

Fill out the form below to send your daycare tips and story ideas to Ed.

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A Study Guide to Humanae Vitae

Written by the Priests and Pastoral Associates of Priests for Life

 

This study guide is based on the Vatican Translation of Humanae Vitae

 

Table of Contents:

 

Forward

Introduction to the Study Guide

Summary of the Introduction to the Encyclical and Section I: New Aspects of the Problem and Competency of the Magisterium

A Summary of Section II. Doctrinal Principles

Summary of Section III. Pastoral Directives 

Essay: Finding Our Way Back Home

Essay: Life, Purity and Humanae Vitae

Essay: The Transmission of Life -- On Whose Terms?

The Contraception of Grief: A Personal Testimony

Glossary of Terms

 

Foreword

 

A Study Guide to Humanae Vitae


Fr. Frank Pavone, National Director, Priests for Life

 

Forty years is not a long time in Church history. Indeed, we are still living in the moment of Humanae Vitae (issued on July 25, 1968), and of the challenge it presents to the world.

Humanae Vitae does not identify the key problem of our day in the realm of sex or birth or "the pill," but rather in the myth that we can be God. Pope Paul writes at the beginning of the document, "But the most remarkable development of all is to be seen in man's stupendous progress in the domination and rational organization of the forces of nature to the point that he is endeavoring to extend this control over every aspect of his own life -- over his body, over his mind and emotions, over his social life, and even over the laws that regulate the transmission of life” (n.2).

 

The Pope here is painting a wider vision of the problem. We think everything belongs to us, but the reality is that we belong to God. "Humanae Vitae" means "Of human life." Human life came from God, belongs to God, and goes back to God. "You are not your own," St. Paul declares. "You have been bought, and at a price" (1 Cor. 6:19-20). Sex and having children are aspects of a whole cluster of realities that make up our lives and activities. We suffer from the illusion that all of these activities belong to us. “This is my life, my body, my choice.

 

The problem we face is not that our society is obsessed with sex. Rather, it is afraid of it-- afraid of the total reality and power of what it represents, where it comes from, and where it leads. Sex properly understood requires that we acknowledge God who made it. More than that, sex can never be separated from its purpose: to insert us into this immense, powerful movement of life and love that started when God said "Let there be light" (Genesis 1:3) and culminates when the Spirit and the Bride say "Come, Lord Jesus!" (Revelation 22:17).

 

Sexual activity means so much that it is wrong to diminish its message or deny its full reality: it belongs in the context of committed love (sealed by marriage) and openness to life precisely because this is the only context great enough to hold its message and reflect the greater reality to which the gift of sexuality points us and to which it commits us.

 

This is a reality that is bigger than all of us. It is the self-giving which starts in the Trinity, and is revealed in a startling way on the Cross, and then challenges each of us in our daily interaction with others, with God, and with our own eternal destiny. It is so real and so big that it is scary. That's why so many today are afraid of the full reality and meaning of sex. That's why Pope Paul VI wrote Humanae Vitae.

 

That is also why our Priests for Life pastoral team wrote this Study Guide. We have also established a special website, www.HumanaeVitae40.com, to promote the teachings of this document. It is our daily prayer that this effort will lead many believers to understand, embrace, and proclaim the beautiful truth of human life. 

 

INTRODUCTION TO THE STUDY GUIDE

 

James J. Pinto, Jr., M.E.V.
Editor: A Study Guide to Humanae Vitae 

 

This Study Guide will be most effective if one first thoroughly familiarizes himself with its content and layout. Review the table of contents and the location of each section listed. The Study Guide is to be used by an individual or group as a side by side companion with the text  of Humanae Vitae included in this booklet. The three Essays offer unique insight with questions for further discussion. The Contraception of Grief: A Personal Testimony presents a riveting and practical witness to why Humanae Vitae is the wholesome truth.

 

The Glossary assists the reader in clarifying some key terms contained in the Encyclical. Glossary terms are listed by the number/paragraph in which they first appear. The terms will be marked with an *asterisk in the Humanae Vitae text as a note to the reader that the term is contained in the Glossary. 

 

After reading Fr. Pavone’s Foreword one should read the Summary of the Introduction and Section I, followed by the reading of the Introduction and Section I. of Humanae Vitae itself. After completing the Introduction and Section I. of Humanae Vitae; the reader answers the series of questions below the Summary of the Introduction and Section I.  The sequence followed for the Introduction and Section I is repeated for each following section: Reading the Study Guide Section Summary, reading of the corresponding Encyclical section itself and returning to the Study Guide questions for that particular section. The questions are meant to refer the reader back to particular paragraphs/numbers (n.or n.n.) of that section where he/she will find the answers. One may work on the answers to these questions while reading the paragraph/number, or, wait until he/she has read the entire section and then complete the answers. Continual returning to the text of the encyclical helps emphasize that the document itself is the primary source of instruction and the basis for individual and group applications. 

 

The three Essays have several questions at their conclusion to help foster reflection and discussion. A personal witness to the truth and wisdom of Humanae Vitae is presented in The Contraception of Grief: A Personal Testimony. 

 

This Study Guide is meant to be a “springboard” to delve more deeply into Humanae Vitae and its themes, in order to stimulate reflection, and a lifestyle of holiness. 

 

For those considering the possibility of facilitating a study group, this study guide lends itself to a discussion study group method of learning. While a leader/facilitator encourages the group and keeps it “on track”, it is the individual sharing and group dynamic that contribute most to the learning process. The facilitator is not a lecturer, neither is he there to give all the answers. The facilitator seeks to shepherd the group learning process and does everything possible to solicit their contributions. Members interact and learn from everyone, including the facilitator. A Facilitator’s Guide is available through Priests for Life at www.HumanaeVitae40.com. The Facilitator’s Guide seeks to assist you in leading a group and lays out suggested study sessions.

 

It is our hope, that on the fortieth anniversary of Humanae Vitae, this study guide will assist in promoting the Church’s clear and authoritative word on transmitting human life. May all who hear this true, prophetic and lovely word be assured that: the Church has always issued appropriate documents on the nature of marriage, the correct use of conjugal rights, and the duties of spouses. These documents have been more copious in recent times. (n.4)

 

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Tips on Take-Home Exams

You may find yourself taking exams "at home" this semester, or least away from the classroom. But the name “take-home exam” has a specific meaning. Unlike in-class exams that are given at a designated time, take-home exams are generally more flexible. You’re given a set of questions or problems several days in advance of the due date; you work on them gradually, taking as much time as you think is appropriate to prepare, write, and revise your answers. Take-home exams are a pretty standard feature in Humanities and Social Science classes. In the document below, however, we attempt to give advice that will be helpful in the Sciences as well.

Prepare, Think, Write, Revise:  This is your mantra.  As soon as you open your take-home exam instructions, read them carefully; read them multiple times.  Then close the screen and jot down the instructions in your paper notebook in your own words. Make double and triple sure you understand the following:

  1. About how long you should take to work on the exam;

  1. Whether you’re allowed to consult sources other than your primary reading for the class;

  1. How you should cite your sources;

  1. Whether or not you’re allowed to consult a peer tutor as you work on the exam (W, Q, S consultant, Peer Advisor, STEM guide, TA);

  1. How long (how many words) are expected for each answer; and

  1. Exactly when the exam is due, and how it is to be submitted.

Read the questions.  Take a walk. No cell phones on this walk.  As you walk, think about the questions (or do one question at a time, one question per walk).  Pull out your handy pocket paper notebook and jot down ideas from time to time.  Remember: if you want to do well, leave your cell phone at home. Trust me on this. 

I find it helps to decide on a number of ideas to aim for.  Walk until you have come up with, say, three points you know you want to make as you answer the question, and three examples you could use to support your ideas.  (If you think of more than three ideas along the way, rejoice.) The numbers help you organize your ideas into categories, and give you a rough outline to work from. Of course, good essays are not a mechanical list of three points!  This is simply a way to get started -- a way to sort out the many ideas that may be darting through your mind.

After you’ve drafted your essays (or solved your problems), get a good night’s sleep.  Revisit your work the next morning; edit for clarity; and add details that support your argument.  

-- Professor Marnie McInnes, English and Peer Advising 

General Strategies for Take-Home Exams in Q Courses

  • Once you’ve completed the exam, double check that every question has been answered

  • Double check that each question has the answer you want associated with it.

  • Where you can, check your solutions by re-substituting them into the original givens.

  • Ask if the problem admits of a trivial solution.

  • Ask if the problem admits of a non-trivial solution.

  • Answer the question asked and not some closely related question.

  • Does your answer make sense?  Does it fall within a natural upper and lower bound?

  • If you can, execute the code. Check its values for special cases.

  • Did you cover a similar problem in class, lab, or as homework? How is this exam problem similar or different?

-- Professor Ash Puzzo, Philosophy and Q Program

From a Math Major’s Perspective

I usually start my take-home as soon as possible. I know that the take-home exams, especially in Math and Science, are generally designed to be more challenging than in-class exams. Thus, starting work on the exam early gives me more time to think through the exam questions. I take advantage of the extra time by double-checking my answers. 

Choosing a good workplace is very important. Find a location that is quiet and free of distractions, including other students. I had one interesting take-home exam experience which I will never forget. I was doing my Statistical Model Analysis exam in a busy airport, between two of my flights. I was definitely tired, rushed, and distracted by the noisy passengers and boarding calls every few minutes. It was much harder to focus on the exam questions in the airport than in my quiet dorm room. Thus, finding a good location (and stable Wi-Fi) is the key to doing well. Of course, the tips for general test-taking still apply: have a good rest and get fully prepared before you start to take the exam.

-- Angela Xinye Yang ‘21 

Purdue Owl

I like the advice the Purdue Owl provides for writing essays during in-class exams.  Their detailed examples and strategies work equally well for take-home exams.  Purdue University Online Writing Lab

-- Professor Susan Wilson, Communication & Theatre, S & W Programs

For Classes with a Great Deal of Reading:

  1. Prepare a study guide with all the terms discussed in class with detailed notes on each term.

  1. Set aside enough time to prepare for, as well as take, the exam.

  1. Take the exam a few days before the deadline so that you’ll avoid feeling rushed.

  1. Make sure to understand the exam rules, as you won’t be able to visit your professor during office hours to ask questions. Before the exam begins, be sure to clarify any uncertainties with your professor via email.

  1. A lot of take-home exams ask you to write essays; thus try practicing your writing before you take the exam itself. Sift through your notes, craft a good question based on a few key points from the class, time yourself, and write an essay answer to your question. This is a great way to both study the material and practice timed writing.

  1. Make sure you give yourself a nice, quiet space with a good Wi-Fi connection. It’s easy to get swept up in conversation with your roommates and friends and lose track of time, so make sure you can get to a place that will be conducive to work. 

-- Tarinni Kakar ‘21 

The Psychology Behind It All

The most important part of the take-home exam is the preparation that comes beforehand.  Make sure to keep up with class reading, take organized notes, and ask any questions you may have. Having a good base of information to use during the exam sets you up to really focus on each question one by one instead of combing through the textbooks on your desk.

I used to make the mistake of relying too heavily on the “open-book” policy that often comes with take-home exams, until I realized that the answers are not always in the reading. You have to understand the material and fully ingest what it's saying.  Use books and notes only as an aide to check details, facts, and figures. 

Also remember that your brain can get tired. Many professors are adding additional and more complex questions because they know that you have more books and notes than you would have in the classroom. Use being at home to your advantage: take a break every now and then. Taking a break allows you to come back to questions with a fresh set of eyes, correct mistakes, and, if need be, add new points. 

-- Helina Samson ‘22

Preparing to Take Your Online Exam

  1. Before taking this exam, make sure that you have studied and spoken to your professor if you have questions. 

  1. Find a quiet place where you can focus without distractions. 

  1. Make sure you are prepared with all the materials you will need to do well on this exam: a charged laptop, textbook, notes, a pencil, and blank pieces of paper. 

  1. Typically take-home exams are more flexible and give you extended time to finish. Take advantage of this and figure out roughly how long it should take you to complete each section. After spending a set amount of time on one section, move on to the next section even if you haven’t quite finished. 

By sectioning your time, you allow yourself to move forward without spending too much time on a single problem. When you have successfully made your way through the entire exam, you can go back to your unfinished sections and try again with a new set of eyes. The extra time benefits you:  if you are really struggling to complete a problem, you can walk away from the exam and return later with a clear mind. I find a great way to clear my head is by taking walks without my cellphone or sitting outside and getting some fresh air. 

-- Olivia Neal ‘22

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Essential Guide to Workplace Investigations

Ruth Mayhew has been writing since the mid-1980s, and she has been an HR subject matter expert since 1995. Her work appears in "The Multi-Generational Workforce in the Health Care Industry," and she has been cited in numerous publications, including journals and textbooks that focus on human resources management practices. She holds a Master of Arts in sociology from the University of Missouri-Kansas City. Ruth resides in the nation's capital, Washington, D.C.

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Study support No result found, try new keyword!Bitesize Study support is the go-to place to support you through your studies and other life challenges. With tips and advice to help with revision, exam stress, bullying and more... we've got you. Fri, 06 Oct 2023 16:18:00 -0500 en-GB text/html https://www.bbc.co.uk/bitesize/study-support Study guide

This bestselling textbook provides an engaging and user-friendly introduction to the study of language.

Assuming no prior knowledge of the subject, Yule presents information in bite-sized sections, clearly explaining the major concepts in linguistics – from how children learn language to why men and women speak differently, through all the key elements of language. This fifth edition has been revised and updated with new figures and tables, additional topics, and numerous new examples using languages from across the world.To increase student engagement and to foster problem-solving and critical thinking skills, the book includes thirty new tasks. An expanded and revised online study guide provides students with further resources, including answers and tutorials for all tasks, while encouraging lively and proactive learning. This is the most fundamental and easy-to-use introduction to the study of language.

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Financial Tips for Study Abroad

The cost of living abroad will inevitably vary from student to student, based upon individual living styles, budgetary habits, personal resources, and the fluctuating currency exchange rates. Taking these factors into account, students may find it difficult to actually estimate expenditures in preparation for a program. Students should be prepared to adapt their standards of living to their surroundings, and approach the experience with a sense of financial responsibility.

Here are some financial tips to remember, in preparation for your time abroad:

Before You Go

Credit/Debit Cards
Contact your bank and credit/debit card companies to let them know you will be abroad (when and where you will be going), so that your withdrawals are not denied or your credit card cancelled. The credit card and/or debit card you plan to use while abroad must be in your name, not your parents'. (Most major lenders will, at the request of the cardholder, provide an additional card in the name of a dependent authorized to use the account.)

ATM Fees
Check with your bank for information about daily/weekly limits on withdrawals, and about fees charged for the use of foreign ATM's. When withdrawing money from an ATM abroad, you will likely be charged a fee at the foreign bank, in addition to your own bank's fee. Ask your bank before you go if they have a partnership bank in the country where you will be living; if so, you might be able to avoid ATM fees.

Foreign Currency
Some places you may be traveling do not always accept credit card as readily as in the U.S. Buy some currency to have when you arrive. You may need money to get from the airport to your accommodation or school, and changing money in airports is often more expensive than at a bank.  Communication with your bank prior to departure is important.  Check with your financial institution regarding the exchange of currency.  It is also helpful to inform your bank of your travel days for leaving and returning to the United States.  

Traveler's Checks
Be aware that traveler's checks are becoming increasingly difficult to cash, especially in Europe.  They are not highly recommended as a primary or secondary source of cash on most programs. 

Flights
Look for student rate flights through companies such as STA and Student Universe. These companies tend to offer cheaper rates for students and other companies may offer cheaper rates for anyone under the age of 26.

 While Abroad

Security
Be careful with purses, wallets, and backpacks, as they are easier targets for pickpockets.  Do not carry all of your money in one place, and if possible, have a secure place to store these items in your dormitory or host family, while you are not intending to use them.

Budget
Always carry your student ID and International Student Identity Card with you, as many places offer students discounts or even free admission. Keep an eye out for student rates, and remember it never hurts to ask! Try to avoid eating out during the week; cooking for yourself and/or eating with your host family will save a lot of money for weekends, travel, souvenirs, etc. 

Travel
When you arrive, consider buying a long-term bus or train pass; a monthly or multiple trip pass is likely a better value than daily passes. Make a budget for travel in addition to your weekly expense budget. Be aware of the current exchange rates in the countries you plan to travel to- this can greatly affect your travel budget.

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Study Abroad Study Abroad

Skip to main contentSkip to main navigationSkip to footer content

ESF Education Abroad is devoted to making transformational international experiences accessible to all ESF students regardless of major, cost, identity, or other defining factors. We do this by working with students on an individual basis to find the opportunities that best fit their personal needs and goals.

ESF students have hundreds of education abroad programs to choose from! Programs vary in length from one week up to a full academic year and are located all over the world, so there is something for everyone! Start to browse programs below, and please reach out to oie@esf.edu with any questions or to start planning your experience abroad.

Programs

Program Details
ESF Short-Term Programs Travel abroad with an ESF faculty member and your classmates! Most short-term courses are between one to three weeks in length and take place over spring or summer break.
ESF Exchange Programs Spend a semester or summer abroad with one of ESF's university partners.
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Fri, 14 Aug 2020 12:08:00 -0500 en text/html https://www.esf.edu/studyabroad/index.php
Transgender treatment: Puberty blockers study under investigation

By Deborah Cohen and Hannah Barnes BBC Newsnight

England's only NHS youth gender clinic lowered the age at which it offers children puberty blockers, partly based on a study now being investigated.

The study's full findings have not been published - but early data showed some taking the drugs reported an increase in thoughts of suicide and self-harm.

The clinic said data was from a "small sample" and so no "meaningful conclusion" could be drawn from it.

Children as young as 11 are now being offered these hormone-blocking drugs.

Experts on clinical trials have criticised the design of the study, which they say makes it hard to tell if the reported effects were due to the puberty blockers or something else. But experts said they warranted further investigation.

The Health Research Authority - which ensures medical studies are ethical and transparent - is now investigating claims brought to them by the BBC's Newsnight programme about the early findings from the study - and the information that is understood to have been shared with patients and parents about the possible effects of puberty blocking drugs.

When a child in the UK is questioning their gender, they can be referred to the Gender Identity Development Service (Gids) at the Tavistock and Portman NHS Foundation Trust in London and Leeds.

One treatment on offer is puberty blockers. They work on the brain to stop the eventual release of oestrogen or testosterone - the sex hormones that increase during puberty. This prevents the development of sex characteristics such as periods, breasts or voice-breaking.

Before 2011, Gids would give puberty blockers to children only once they had turned 16.

But as gender clinics around the world began providing blockers to those who had just begun puberty, reports grew of UK children going overseas to buy the drugs.

And in 2011, a medical study was approved through which younger children could access these drugs.

'A life-changing step'

Acknowledging the weak evidence for the drugs, the research team, made up of Gids and University College Hospitals staff, set out to "evaluate the psychological, social and physical effects" of the blockers on a carefully selected group of young people.

Details about risks - such as potential adverse effects on bone strength, the development of sexual organs, body shape or final adult height - were provided in a patient information sheet. But Newsnight found certain information had not been included.

Previous research had suggested all young people who took the blockers went on to take cross-sex hormones - the next stage towards fully transitioning to the opposite gender. But patients and parents were not told this in the information sheet.

"I don't see that the parents and their children could really have given informed consent given the lack of information that was provided," said Michael Biggs, associate professor of sociology at Oxford University.

Prof Biggs, who has attracted criticism from some in the transgender community for his views, added: "They were not given the information they needed in order to take this momentous life-changing step."

He gave Newsnight a series of documents relating to the research study he had obtained via freedom of information requests, which were independently looked at.

Gids, together with lead investigator Prof Russell Viner, said: "We are confident that informed consent was obtained."

He said the "possibility that blocking puberty may crystallise gender identity" had been raised with the patients and parents.

Preliminary data for 30 of the 44 young people on the study was made available to the Tavistock's board in 2015. It showed that after a year on puberty blockers, there was a significant increase found in those answering the statement "I deliberately try to hurt or kill myself".

Prof Susan Bewley, who chairs Healthwatch, a charity for science and integrity in healthcare, is one of a number of doctors raising concerns about the lack of evidence in this area of medicine.

She said seeing any change around suicidal thoughts "is very worrying".

"Good medical practice would normally be very reflective about an increase in harms," she added.

Because of flaws in how the study was set up, it is not possible to infer cause and effect or even to say whether rates of suicidal thoughts are higher or lower in this group than in children with gender dysphoria who don't take puberty blockers.

The study had no control group, of children not taking the drugs, to compare results with. In addition, the outcomes it was measuring were unclear.

Nevertheless, experts say these observations should have given Gids pause for thought.

Gids told Newsnight: "All patients were seen regularly by mental health professionals. They concluded that there was no evidence of harms that could be directly attributed to the treatment and that continuation of the study was appropriate."

This early data was not shared with the Health Research Authority, despite its demands for updates on the study over a period of three years.

In response to Newsnight sharing this preliminary data and other concerns about the study, Teresa Allen, chief executive of the HRA, said: "The information that Newsnight has brought to our attention has not been raised with us before.

"We will therefore investigate further, which may include a review of the original ethics opinion."

The HRA told Newsnight they do not currently have all the information they need. They have reviewed minutes from the ethics committee that approved the study and these have not raised a specific concern.

'Nothing could have stopped me'

Hannah Phillips, 19, started taking puberty blockers when she was 16. She said the doctors had been clear about how little was known about the treatment and explained that it was "in testing".

"I don't think there could have been anything that the doctors could have said to stop me from wanting to go on to hormone blockers," the Youtuber told Newsnight.

While acknowledging the need for more research, Ms Phillips said there shouldn't be a halt to the current rules that allowed young people access to puberty blockers.

Receiving treatment "feels as if someone's just finally listening to you", she said.

Newsnight's investigation comes amid growing concern over the way Gids is operating.

In an open letter last week, former Gids clinician Dr Kirsty Entwistle raised concerns over the way puberty blockers were being presented to children as "fully reversible", when their long-term impact was unknown.

She also said staff were unable to raise concerns without risking being branded transphobic.

Tavistock and Portman Trust chief executive Paul Jenkins told BBC Radio 4's Today programme: "Puberty blockers are reversible."

He said Gids was looking at processes to make it easier for clinicians to focus on their work, "rather than being swayed or influenced by the very heated debate", but concerns over staff being falsely accused of transphobia had not been raised in the organisation.

However, a former Gids member of staff told Newsnight: "Myself and countless colleagues raised concerns in all the forums available to us."

And in a statement last year, the trust said concerns that staff were facing allegations of transphobia revealed "a negative attitude to... gender identity".

Policy change

In 2014, despite the patchwork of information about the study - which was still running - a change in Gids' policy was approved by NHS England: children with gender dysphoria, who were just beginning puberty, could now be eligible for blockers.

Gids' data suggests that between 2012 and 2018, 267 people under the age of 15 started using the blockers.

The service told Newsnight the use of hormone blockers at this earlier age "remains only available to a carefully selected group".

NHS England says the policy change followed an evaluation of the study. Newsnight has asked for a copy of this evaluation - but none was provided.

An NHS England official said its "2016 service specification for gender identity services was based on international evidence and developed with clinical experts and publicly consulted on".

"The specification will be reviewed," they added, which would include "a review of the most up-to-date research... and advice from clinical and academic experts".

If you are affected by any of the issues raised in this article, you can find support and advice via BBC Action Line.

You can watch Newsnight on BBC Two weekdays at 22:30 or on iPlayer, subscribe to the programme on YouTube and follow it on Twitter.



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Sun, 21 Jul 2019 21:12:00 -0500 text/html https://www.bbc.com/news/health-49036145




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