Full Name (As It Appears on Your Passport)

OFF-CAMPUS PROGRAMS Application for Westmont in Uganda, Fall 2017

Application Deadline: November 29th, 2016, 5pm OCP Office BIOGRAPHICAL INFORMATION Name: Last First Middle Initial

Student ID:

Date of Birth: Mail Box:

Phone: Cell Phone:

Westmont E-mail: Other/Personal E-mail:

Permanent Address: Street

City State Zip Parent/Guardian Name (Emergency Contact):

Address: Street City State Zip Home Phone: Work Phone:

E-mail: Cell Phone:

Are you a U.S. citizen? If no, country of citizenship:

If not a U.S. citizen, are you a permanent U.S. resident?

Do you have a passport that will be valid until 21 June 2018? ______If so, provide your passport information below. If not, provide your passport information when it’s available. But go ahead and submit your application without waiting for passport information. Full Name as Issued on your passport______

Passport Number: Passport Agency/Authority:

Date of Issue: Date of Expiration: ACADEMIC INFORMATION

Current Class Standing: Fr. So. Jr. Sr. Graduation Date:

Major: Minor: ESSAY QUESTIONS This is an important part of your application. Take time to answer each question thoughtfully and honestly. Responses to questions 1-3 should be approximately one paragraph (half page); responses to question 4 may be briefer. Attach your typewritten answers to this application. Please double-space and number each essay.

1. What do you want to get out of the Westmont in Uganda Semester other than the usual joys and challenges of tourism? What are your educational goals for the program and how will they contribute to your overall Christian liberal arts education at Westmont?"

2. Uganda is a society that values social conformity over individual expression. Discuss what aspects of physical appearance, behavior, or ideals you hold that you might find difficult to compromise. Describe an instance when you subjected your individuality to a larger, community expectation. 3. What have you found to be the most valuable aspect—and the most challenging aspect—in your experience of living on campus as part of the Westmont community?

4. All students applying to the Global Health Emphasis (GHE) please complete the following essay. The GHE is for students in medical and public health related majors who want the opportunity to complete an international global health practicum at a local organization in Uganda. For more detailed information, please see the USP academics page at: https://www.bestsemester.com/usp/academics/. NOTE: Global Health students must also choose to live either with a host family for the full semester or in the dorms on campus. You must also compete the respective essay for the living context of your choice. All on-campus students will participate in a two-week homestay near Uganda Christian University and all students will complete a one-week rural homestay.

.a One major aspect of the Global Health Emphasis (GHE) is the semester-long global health practicum. After reading the GHE description on the website, please answer the following questions: (1) Why do you wish to conduct a global health practicum in Uganda? (2) Discuss potential challenges of working at a practicum site in a cross-cultural setting. (3) What population (i.e. children, elderly, physically disabled, hospital patients etc.) or setting (i.e. hospital, clinic, community development organization etc.) are you most interested in working with in Uganda and why?

.b Practicum Interests (circle all that apply): clinical, physical therapy, public health, nutrition

.c Do you prefer 36 hours (1-unit) or 72 hours (2-unit) of internship experience?

.d Any other information or requirements relevant to your major:

5. Please highlight which side of the chart most describes you for each row. This has no bearing on your acceptance, but will help us place you with a family/roommate/practicum site pending your acceptance to the program

Introverted: have a need for substantial personal time/space Extroverted: do not require a lot of personal time/space

High level of initiative with people and activities Enjoy participating when others take the lead

Shy personality Outgoing personality

Enjoy a lot of physical activity Enjoy less active activities

Adaptable in terms of schedule/routine Routine is important

Faith expression is more traditional Faith expression is more charismatic

Tend to keep living space neat and tidy Laid back about the appearance of living space ADVISOR’S APPROVAL FOR PARTICIPATION IN THE PROGRAM--II have met and discussed the coursework offered on this study abroad program with my advisee and how it applies to his/her plan for gradation (including meeting major and GE requirements). My signature indicates my consent for this student to register for Westmont in Uganda Fall 2016.

Advisor’s Name: Signature ______Date

RECORDS OFFICE APPROVAL (Applicant should take this to the Records Office to be completed prior to turning in your application) ❐ NO Westmont GPA is available—please circle TRANSFER 1ST YEAR ❐ Applicant has at least a 2.3 gpa—please circle YES NO

❐ If the student will complete 59 units by the end of the current semester, he or she has officially declared major(s) and minor(s). ❐ If the student will complete 70 units by the end of the current semester, he or she has requested an Application for Degree for every major and minor planned. Forms must be submitted to the Records Office prior to your departure abroad. Signature: Date:

STATEMENT OF UNDERSTANDING, PERMISSION FOR RELEASE OF INFORMATION, AND WITHDRAWAL DEADLINES

1. I certify the information given on this application to be correct and I agree to abide by all the rules, regulations, and requirements of Westmont College and the Off-Campus Programs Department. 2. I understand that my participation in an Off-Campus Program is conditional upon (a) obtaining medical clearance for any current mental or physical health issue, or should a mental or physical health issue arise prior to departure for the program (b) maintaining satisfactory academic (minimum 2.3 cumulative GPA) and student life standing at Westmont College, (c) my application being reviewed and approved by those responsible for selection. It may also be contingent on the availability of appropriate facilities or services at the host institution to provide for any special health conditions I may have. 3. I hereby permit Off-Campus Programs to make the information contained in this set of application papers available to the parties directly involved in my placement in a host institution and to government agencies, such as consulates, for visa purposes. 4. I hereby authorize the registrar to release my academic records to Off-Campus Programs as required. 5. I hereby authorize those parties involved in my admission to an off-campus program to consult with Disability Services, and with the Student Life Department regarding my record as a member of the community. 6. I understand that if I wish to restrict disclosure of “directory” information, which is normally released by Off-Campus Programs without student consent, I must notify Off-Campus Programs in writing. 7. I understand that Off-Campus Programs students remain eligible for Westmont financial aid. Financial aid includes, but is not limited to, Title IV Federal Aid programs (with the exception of Federal Work Study) based on the student’s financial need. In addition, I understand that Westmont grants and loans may only be used once for approved programs other than the Europe, England, Mexico and SF Urban Westmont programs. 8. I understand that I must be cleared with the Business Office and Chaplain’s Office to register for the semester in question in order to participate in this Off-Campus Program as a Westmont student. 9. I have discussed my participation in this program with my academic advisor and have made the plans necessary to complete all parts of the general education and major program without special accommodation by Westmont College. 10. I understand that I may not enroll in two off campus programs in consecutive semesters. 11. I understand that Westmont College will follow the grading policies (e.g. regarding pass/no pass availability, withdrawal deadlines) of the off campus program 12. I understand that if I end up changing my classes once I arrive at the program, I must contact my advisor and the records office immediately ([email protected]) to receive approval for any changes. 13. I understand that students enrolling in an off-campus program are subject to all of the same registration deadlines and eligibility requirements as apply for on-campus registration.

14. I agree to receive all information/updates via email and will be responsible to read email related to Westmont in Uganda 2017.

Signature of Student: Date:

Please return all forms to the Off-Campus Programs Office no later than November 29th, 2016 Westmont in Uganda, Fall 2017

Faculty Recommendation

Application deadline November 29th, 2016 For the student to be fairly considered, it is vital that all recommendations be in by the deadline.

Applicant: Please fill out this portion and give to a current or past faculty member (1st year students may use a high school teacher)

Applicant’s Name:

Name of Reference: Title:

Circle One: I agree or do not agree to waive my right to access this reference

Applicant’s Signature: Date:

1. How long have you known the applicant?

2. Please indicate how well you know the applicant:

❐Very Well ❐Moderately Well ❐Limited Contact

3. Please indicate this student’s academic competencies. Comment on areas such as intellectual curiosity, academic motivation, capacity for critical thinking, respect for others with different viewpoints, willingness to assume personal responsibility for own learning:

4. Please indicate any other factors, which should be taken account of in considering this student’s application (spiritual, social, emotional, mental and physical condition, etc.) Please include any suggestions that would be helpful for our faculty in working with this student:

Your Name: Date:

Title: Dept/ Org.:

Phone Number:

PLEASE RETURN TO: Off-Campus Programs Office, Westmont College, 955 La Paz Rd, Santa Barbara, CA 93108. Fax: 805-565-7142 or email: [email protected] Westmont in Uganda, Fall 2017

Personal Recommendation

Application deadline: November 29th, 2016 For the student to be fairly considered, it is vital that all recommendations be in by the deadline.

Applicant: Please fill out this portion and give to reference—someone who knows you well but not a family member or fellow student.

Applicant’s Name:

Name of Reference: Title:

Circle One: I agree or do not agree to waive my right to access this reference

Applicant’s Signature: Date:

1. How long and in what capacity have you known the applicant?

2. Please indicate the student’s emotional maturity and adaptability. Comment on areas such as: adaptability to new situations, interpersonal skill, emotional maturity, self-confidence/self-esteem, ability to function as part of a group, skill in self-appraisal, initiative, leadership abilities, capacity for relating to those with differing beliefs or values.

3. Describe this student's level of Christian maturity, commitment and understanding:

4. Additional remarks or other issues we should be aware of. Please include any suggestions that would be helpful for our faculty in working with this student.

Your Name: Date:

Title: Dept/ Org.:

Phone Number:

PLEASE RETURN TO: Off-Campus Programs Office, Westmont College, 955 La Paz Rd, Santa Barbara, CA 93108. Fax: 805-565-7142 or email: [email protected]