LEARNING JOURNEY APPLICATION FORM

Contents

Part One: Part Two: Part Third: Part Four: Part Five: Part Six:

Introduction Personal Information Applications Questions References Scholarship Questions Disclaimer and Signature

Page 2 Page 3 Page 4 Page 7 Page 8 Page 9

PART 1: Introduction A. Instructions & Guidelines

Please fill out this application thoroughly and thoughtfully. You will need Microsoft Word to view and fill out this form. Once you have completed the application in its entirety, save the file, then you may print a copy for your records, and send a copy of the final version to nishma@connectindia.org. Successful applicants will be contacted to organise a time for their telephone interview. The applications are due on 22 May 2014. Do keep in mind that this is a rolling admissions process, so if all seats for the 2014 program fill up prior to the deadline, completed applications received may not be considered. Once all the seats are filled, there will be a notice posted on the website. Applicants will be notified by email of their acceptance into the program. Upon acceptance, final participants will need to pay the programme price of 850 by cheque or transfer. Please note that a student discount of 15% will be available on the progamme price, for which valid proof will be requested prior to approval.

B. Checklist
A completed application consists of: (1) a completed Personal Information form; (2) completed Applications Questions; (3) a list of 2 references; and (4) a current CV. Please note that Connect India may contact references and request supplemental materials during the application process.

C. Application Deadline
23:59 on Thursday 22 May 2014.

For more information: www.connectindia.org |

For help: nishma@connectindia.org

PART 2: Personal Information

Personal Details Surname First Name Gender Contact Details Telephone Email

Title Date of Birth

Mobile

Languages Have you been to India before? If yes, where? Do you speak any relevant languages? If yes, please list and state proficiency (basic, good, fluent)

PART 3: Application Questions About You

1. What is a tough challenge you have faced? How did you approach it? What did you learn from the experience? 200 words

2. Name one personal quality that youd like to develop. Explain. 100 words

Motivation
3. What is the one thing about Learning Journey that has attracted your interest and how is this relevant to you right now? 100 words

Community Involvement
4. In what ways have you been involved in your community? (For example, this can include examples from your college, university or workplace). Briefly describe the activities, your role, and what you learnt? 200 words

5. Name one thing you would like to change about the world. 100 words

India
6. What role does India play in how you define your identity? 200 words

Perspectives
7. Learning Journey embraces the philosophy of simple living. Please tell us what this means to you? 100 words

8. Please describe the last time you felt alive in one sentence.

Other
9. Please state where you heard about Connect India and/or Learning Journey.

PART 4: References
Please list two references. These references should be able to speak to your character, personality, motivation, and/or previous work. You are not required to send in references/recommendations in addition to this form. References may be contacted upon receipt of application, so be sure to provide current information. Reference 1 Full Name Relationship

Address

Email

Telephone

Mobile

Reference 2 Full Name Relationship

Address

Email

Telephone

Mobile

PART 5: Scholarship (please only fill in if you would like to apply for a scholarship)
Connect India is able to offer full and partial scholarships for the trip in specific circumstances. If you would like to apply, please answer the following questions and please specify whether you are applying for a full or partial scholarship. Please state the amount () of scholarship you would like to apply for?

Outline why you think you deserve to be considered for a scholarship. 100 words

Tell us what you think you will contribute to Learning Journey group. Please specify skills, knowledge and/or past experience? 100 words

PART 6. Disclaimer and Signature

I certify that my answers on this application are true and complete to the best of my knowledge. If this application leads to my participation in Learning Journey 2014, I understand that false or misleading information in my application or interview may result in my release. Signature Print Name Date