Paid Summer Field Internship Opportunity with the UCSD Cross-Border Initiative
APPLICATION FORM
Applications due: April 11, 2016.
Successful Applicants notified: May 1, 2016.
Please save the completed form as a pdf file and send by email to Khushbu Gokalgandhi via .
Participating programs
In which program are you currently participating?
The 2016 Blum Summer Field Internship is partnering with the following 10 programs across the UCSD campus. Undergraduate students enrolled in these programs will be given priority. However, several spots will be reserved for students in other programs who are uniquely suited with skills, experiences and interests that will benefit, and be benefitted by, participation in the internship.
Global Ties / Engineering / ☐ / Partners at Learning / Education Studies / ☐Global Health Program / ☐ / Thurgood Marshall College Public Service Minor / ☐
Human Rights Minor / ☐ / Environmental Engineering / ☐
Sixth College Practicum / ☐ / Earth Sciences (Environmental Education) / ☐
Urban Studies & Planning / ☐ / BS in Public Health (School of Medicine) / ☐
Other: ______
Student Information
Please provide the following information:
Full Name:Last
/First
/M.I.
Student ID:Address:
Street Address
/Apartment/Unit #
City
/State
/ZIP Code
Phone: /Email:
Additional Student Information
Major: /Year:
GPA: /College:
Border crossing
Do you have a current passport and (if needed) required visa to cross into Mexico (for students interested in the Laureles canyon site that forms part of the Cross-Border Community Station)? / YES☐ / NO
☐
Emergency contact information
Please provide two names to contact in case of an emergency:
Contact 1:
Full Name:Last
/First
/M.I.
Relation:Phone (Home): /
Phone (Work):
Contact 2:
Full Name:Last
/First
/M.I.
Relation:Phone (Home): /
Phone (Work):
Volunteer / Work Experience
Please describe two past or current relevant volunteer / work experiences:
I. Dates:From (mm/yyyy) / To (mm/yyyy)
Organization:
Position:
Supervisor:
Supervisor email:
Description of Activities / Roles:
350 Character Limit (w/spaces ~ 55 words)
II. Dates:From (mm/yyyy) / To (mm/yyyy)
Organization:
Position:
Supervisor:
Supervisor email:
Description of Activities / Roles:
350 Character Limit (w/spaces ~ 55 words)
Essays
1. Why are you interested in participating in BSFI this summer?
1,500 Character Limit (w/spaces ~ 225 words)
2. Do you have previous field research and/or community engagement experience? If so, please describe
1,000 Character Limit (w/spaces ~ 150 words)
3. Could you describe your career goals after college and how they relate to public service?
1,000 Character Limit (w/spaces ~ 150 words)
Preference of Community Station
There are three Community Stations field sites available in Summer 2016. In which of the three stations would you prefer to participate? Please rank your preferences 1, 2, 3.
More information about the community stations is available via: http://blum.ucsd.edu/CommunityStations-BCB.html and http://blum.ucsd.edu/CommunityStations-EL.html
Cross-Border Community Station at Casa Familiar (San Ysidro, California) / ____Cross-Border Community Station at Alter Terra (Tijuana, BC, Mexico) / ____
EarthLab Community Station
(Encanto, San Diego, California) / ____
Spanish proficiency
How would you rank your Spanish proficiency?
(Refer to https://en.wikipedia.org/wiki/ILR_scale)
0 = No Proficiency
/1 = Elementary Proficiency
/3-Limited Working Proficiency
/4-Professional Working Proficiency
/5-Full Professional Proficiency
/6-Native or Bilingual Proficiency
Questions / Concerns / Comments
Please detail any concerns and questions you may have4