Student Application Form
ExploringAfrica: Botswana
Summer “A” 2017
(May 4-June 2, approx.)
Date Application Submitted: ______
For best consideration, submit application as soon as possible, and preferably before Oct. 15th, as we will begin interviewing and selecting students in that date. We will continue to review applications until all ten positions are filled, or February 1, 2017 (whichever comes first).
General Information
1. Name (First, Middle, Last):
2. Primary Email Address:
3. Primary Mailing Address:
4. Primary Phone Number:
5. Date of Birth:
6. Country of Birth:
7. US Citizen: Yes ___ No ___
8. Gender: Female ___ Male ___
9. Languages (other than English)That You Speak or Have Studied:
Language / Home Language? / Years Studied / ProficiencyIf additional space is needed, please use the back of this page.
Academic Information
10. UCF PID:
11. Academic Major (all majors welcome):
12. Academic Minor:
13. Academic Level (Graduate, Undergraduate, Junior etc.):
14. Expected Date of Graduation:
15. Do You Receive Financial Aid? Yes___ No ___(If yes, list your Financial Aid Program):
16. Florida Resident for Tuition? Yes___ No ___
17. Expected Spring 2017 Class Schedule:
18. Expected Summer 2017 Class Schedule:
19. Overall GPA:
Travel Information
20. Current Passport Number (If you do not have a passport, list “None”):
21. Passport Expiration Date:
22. Have You Traveled to States Beyond Florida? Yes___ No ___ If yes, please list:
23. Have You Traveled Outside the US? Yes___ No___. If yes, please complete the following:
Country / Purpose of Visit / Approximate Time in CountryIf additional space is needed, please use the space available on the last page.
Additional Experiences
24.Have you completed (or are currently enrolled in) courses related to education, sociology, anthropology, social sciences, political science, or TESOL? Yes___ No___. If yes, please list up to five:
25. Have you had experience communicating with individuals who do not have English as their primary language? Yes ___ No ___
If yes, please describe how these experiences might better prepare you for the study abroad program in Botswana, includingBotswana schools.
26. Have you had any experiences in high-needs and/or multicultural schools, community organizations (such as homeless shelters), youth organizations/clubs, summer camps, coaching etc.? Yes ___ No ___.
If yes, explain briefly:
27. List any field experiences/internships within your major/minor that you have completed, or are currently enrolled in. If more than three, please list the experiences you feel were most important.
a)
b)
c)
How might these experiences prepare you for your experience in Botswana and in Botswana schools?
28. Why do you want to participate in this study abroad program inBotswana?
29. Given your skills and experiences, what would you contribute to this study abroad program in Botswana?
Emergency Contact:
30. Contact’s Name:
31. Relationship (parent, friend etc.)
32. Contact’s Email Address:
33. Contact’s Phone Number:
34. Contact’s Mailing Address:
References:
35. List two references (college faculty; community organization leader; UCF faculty)
Name / Position / Email/Phone/Address*Please attach an unofficial audit with this application (if you are having difficulty attaching, please contact )
E-MAIL COMPLETED APPLICATIONS TO:
Dr. Karen Biraimah
Director, International and Special Programs
College of Education and Human Performance.
ED 209H
407-823-2428
OR
Ms. Lindsay Archambault
Coordinator, International and Special Programs
ED 206F
407-823-2881
For best consideration, submit application as soon as possible, and preferably before October 15th, as we will begin interviewing and selecting students in that date. We will continue to review applications until all ten positions are filled, or February 1 (whichever comes first).
?????????????????????????????? Questions ???????????????????????????????????
Dr. Biraimah is more than happy to discuss this program in greater detail, and will answer any questions you might have. Feel free to drop by her office, or to contact her via email/phone.
Ms. Archambault has worked with the Botswana program for years, and is also a great source of additional information.
C: Botswana 2017 Student Application
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