Center for Global Engagement & Buffet Center at Northwestern University

Northwestern University GESI 2012

This form is a mandatory supplement for the Global Engagement Studies Institute program. It must be completely filled out and submitted along with the Northwestern University Summer Study Abroad application for participants to be considered for the GESI programs in Bolivia, the Dominican Republic, India, Nicaragua, South Africa* and Uganda.

Please visit: http://www.gesi.northwestern.edu/application-process/ to review the GESI 2012 application process in detail.

If you have any questions while filling out this form, please email us at: gesi@northwestern.edu.

We look forward to receiving your application.

Warm regards,
The GESI Team

*Only students applying to the South Africa site should complete section VIII of this application.

I. PERSONAL INFO
1. Name * First Last
2. Gender *
Female Male
3. Date of Birth * MM / DD / YYYY
4. Permanent Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
5. Race/Ethnicity *
Asian, Native Hawaiian, or Other Pacific Islander American Indian or Alaska Native Biracial/Multiracial Black or African-American Caucasian/White Hispanic or Latino/a Other (please list below)
6. NetID (Northwestern students only)
7. Email *
8. Phone * ### - ### - ####
9. If you're interested in connecting with GESI and other participants via social media if accepted to the program, please provide us with the direct links to your Facebook account, twitter, and/or LinkedIn profiles.

Optional and won't impact admissions decisions.
II. ACADEMIC INFO
1. College or University *
2. City, State (of your college or university) *
3. NU students, list the School(s) you are currently in.
Non-NU students, please skip this question.

Northwestern students only. If you are double-degree student in a 5-year program, list both schools.

If you are applying to transfer schools, list both schools. Complete the rest of this application based on the school to which you are transferring, unless you are applying to transfer to Medill, in which case you should complete this application based on the school in which you are currently enrolled.
4. List all of your declared and/or intended majors and minors.

1st Major *

If you are currently undeclared, you do not need to declare a major before submitting this application; if you have a major in mind, please complete this application based on that plan.

If any major or minor is currently undeclared, check the undeclared box.
Undeclared

If any major or minor is currently undeclared, check the undeclared box.
2nd Major (if applicable)

If any major or minor is currently undeclared, check the undeclared box.
Undeclared

If any major or minor is currently undeclared, check the undeclared box.
1st Minor (if applicable)

If any major or minor is currently undeclared, check the undeclared box.
Undeclared

If any major or minor is currently undeclared, check the undeclared box.
2nd Minor (if applicable)

If any major or minor is currently undeclared, check the undeclared box.
Undeclared

If any major or minor is currently undeclared, check the undeclared box.
5. Which language(s), if any, have you studied at the university level?
List the last course(s) you took in each language and the term(s).
6. What is your current, cumulative GPA? *
7. What is your expected graduation date? (month/year) *
8. When you study abroad, what year will you be preparing to enter at your university? (E.g. If you are a GESI student the summer after sophomore year, consider yourself a junior.) *
Sophomore Junior Senior Recent Grad
9. Have you had any student conduct and/or academic issues at your home college or university? *
Yes No
10. Are you an international student? *
Yes No
If yes, list your home country:
11. List your country or countries of citizenship. *
12. Do you currently receive financial aid through your university, federal or state grants and loans, work-study, and/or employee discounts? *
Yes No
13. Do you receive faculty/staff tuition rebate from your university? *
Yes No
14. Do you receive athletic aid from your university? *
Yes No
15. If selected to participate in the program, can we list your name and email on the Northwestern study abroad website so that other students on the program can contact you? *
Yes No
III. PARENTS OR GUARDIAN CONTACT INFO

Northwestern may use the following information in case of emergency and for correspondence purposes. In addition, Northwestern may release information regarding the study abroad student to the contacts listed here.
1. Contact 1 - Name * First Last
Emergency Phone Number *
Other Number
Email Address *
Street Address: *
City, State & Country *
Relationship to you *
2. Contact 2 - Name First Last
Emergency Phone Number
Other Number
Email address
Street Address: *
City, State & Country
Relationship to you
IV. ATTACHMENTS
1. STATEMENT OF PURPOSE
Please upload one word document that contains answers to each of the following questions. If your first choice country is the Dominican Republic, Bolivia, or Nicaragua, please answer question 1 and 2 in Spanish.

1. Why are you applying to the GESI program? (200 words max)

2. Please review GESI's Student Code of Conduct available here: http://www.gesi.northwestern.edu/admitted-students/. Identify which expectation would be most challenging for you, and explain why you think this requirement is in place. (200 words max)

3. If your cumulative GPA is below a 3.0, briefly explain why your GPA fell below a 3.0 and give a detailed explanation for how you plan to raise it. *

Please make sure your name and email ID are clearly marked.
2. RESUME
PLEASE UPLOAD YOUR RESUME. *
V. PLACEMENT

The answers to the following questions will help us better understand what program site would be the best fit for you.
1. Is Bolivia your: *
First Choice Second Choice Third Choice Fourth Choice Not interested
2. Is the Dominican Republic your: *
First Choice Second Choice Third Choice Fourth Choice Not interested
3. Is India your: *
First Choice Second Choice Third Choice Fourth Choice Not interested
4. Is Nicaragua your: *
First Choice Second Choice Third Choice Fourth Choice Not interested
5. Is South Africa your *
First Choice Second Choice Third Choice Fourth Choice Not interested

If South Africa is your first or second choice, you must answer the additional questions in Section VIII of this application.
6. Is Uganda your: *
First Choice Second Choice Third Choice Fourth Choice Not interested
6. Please explain how important this ranking is to you. *
7. If you are interested in the Dominican Republic, Nicaragua or Bolivia, please indicate how many years of college Spanish or the equivalent you've had. How comfortable are you expressing your thoughts in Spanish?
9. Issue Areas
Which of the following issues do you most want to work on during GESI and why? (Public health, social entrepreneurship and business creation, youth, education, microfinance, women's empowerment, or environment) *
10. Do you have a preference for: *
Rural placement Urban placement No preference
11. What is the longest amount of time you've spent outside the country? Please list the countries in which you have traveled. *
VI. SCHOOL POLICY

All non-Northwestern applicants MUST ask their home universities about their policies with regard to credit transfers and enrollment in external study abroad programs before applying to the GESI program.
1. Have you checked with your study abroad (or comparable) office to see if your university has any constraints on your ability to receive credit from other universities?

Yes No
2. Is there anything specific we need to be aware of with regard to your university's policy for credit transferability?
VII. SCHOLARSHIP (Northwestern students only)

At this time, only Northwestern applicants will be considered for limited GESI financial aid. If you are a non-Northwestern student, please check with your home institution for financial aid or scholarship opportunities.
1. If you are a Northwestern student seeking need-based scholarship funding, please write a paragraph about why you wish to be considered for a scholarship, how much scholarship money you require, along with an explanation of any extenuating financial circumstances of which we should be aware.
VIII. SOUTH AFRICA program applicants only

If you are interested in being considered for the GESI site in South Africa, you must complete the following question. The site is specifically designed for students with a demonstrated interest in social entrepreneurship and social enterprise development.
1. Define social entrepreneurship. What might be the limits/challenges of social entrepreneurship?
IX. OTHER

This section is for information purposes only.
If enrolled in GESI, where do you anticipate staying during the Pre-Departure Learning Summit (June 15-21) and the Final Reflection Summit in Evanston (August 18-20)? *
With the GESI group in a hostel/hotel With family or friends in Evanston/Chicago I'm not sure at this time
How did you hear about GESI? *
Websearch Google Ad Email flyer Info Session GESI representative spoke to my class School Study Abroad Office Fair (study abroad, internship, etc.) College adviser or professor (please state his/her name in box below) Student group (please specify in box below) GESI alumni (please state his/her name in box below) Other (please state in box below)
X. BASELINE QUESTIONS

Your answers are intended to help us plan summer programming and will NOT affect admissions decisions.
1. What qualities are necessary to work with communities abroad/to serve/to make a difference? (200 words max)
2. How do you define "poverty"? (200 words max)
Please choose ONE of the following questions to answer in less than 200 words:

--Why are some countries rich and others poor?

--What are the key components or conditions necessary for a country to develop?

--Which of the United Nations Millennium Development Goals most resonates with your interest in GESI?
Do Not Fill This Out

Center for Global Engagement & Buffet Center at Northwestern University

I. PERSONAL INFO

II. ACADEMIC INFO

III. PARENTS OR GUARDIAN CONTACT INFO

IV. ATTACHMENTS

1. STATEMENT OF PURPOSE

2. RESUME

V. PLACEMENT

9. Issue Areas

VI. SCHOOL POLICY

VII. SCHOLARSHIP (Northwestern students only)

VIII. SOUTH AFRICA program applicants only

IX. OTHER

X. BASELINE QUESTIONS