<p> 2017 BLUM SUMMER FIELD INTERNSHIP AT UC-SAN DIEGO Paid Summer Field Internship Opportunity with the UCSD Cross-Border Initiative APPLICATION FOR UC-WIDE STUDENTS</p><p>Internship date: June 29 – August 18 (partial participation is not permitted)</p><p>Successful applicants will receive a $3,000 stipend, plus living accommodations in San Diego for the duration of the Internship. </p><p>Spring / Summer 2017 graduates are not eligible to apply.</p><p>APPLICATION FORM</p><p>Applications due: April 5, 2017. Successful Applicants notified: April 17, 2017.</p><p>Please save the completed form as a pdf file and send by email to Khushbu Gokalgandhi via [email protected].</p><p>Participating programs</p><p>At which UC campus are you earning your degree? </p><p>What is your Major?</p><p>Please provide contact information for a faculty member at your home university who we can contact about your application.</p><p>Student Information</p><p>Please provide the following information:</p><p>Full Name: </p><p>Last First M.I.</p><p>Student ID: </p><p>Address: </p><p>Street Address Apartment/Unit #</p><p>City State ZIP Code 1 Email: Phone: </p><p>Additional Student Information</p><p>Year: Major: </p><p>College GPA: </p><p>Border crossing</p><p>YES N Do you have a current passport and (if needed) required visa to cross into Mexico (for O students interested in the Laureles canyon site that forms part of the Cross-Border ☐ ☐ Community Station)? </p><p>Emergency contact information </p><p>Please provide two names to contact in case of an emergency:</p><p>Contact 1:</p><p>Full Name: </p><p>Last First M.I.</p><p>Relation: </p><p>Phone (Home): Phone ( W o r k</p><p>2 ) :</p><p>Contact 2:</p><p>Full Name: </p><p>Last First M.I.</p><p>Relation: </p><p>Phone ( W o r k ) Phone : (Home): </p><p>Volunteer / Work Experience </p><p>Please describe two past or current relevant volunteer / work experiences:</p><p>I. Dates: </p><p>From (mm/yyyy) To (mm/yyyy) Organization: </p><p>Position: </p><p>Supervisor: </p><p>Supervisor email: </p><p>Description of Activities / Roles:</p><p>3 350 Character Limit (w/spaces ~ 55 words)</p><p>II. Dates: </p><p>From (mm/yyyy) To (mm/yyyy) Organization: </p><p>Position: </p><p>Supervisor: </p><p>Supervisor email: </p><p>Description of Activities / Roles: 350 Character Limit (w/spaces ~ 55 words)</p><p>Essays</p><p>1. Why are you interested in participating in BSFI this summer? 1,500 Character Limit (w/spaces ~ 225 words)</p><p>2. Do you have previous field research and/or community engagement experience? If so, please describe 1,000 Character Limit (w/spaces ~ 150 words)</p><p>3. Could you describe your career goals after college and how they relate to public service? 1,000 Character Limit (w/spaces ~ 150 words)</p><p>Preference of Community Station</p><p>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. If you are not willing to work at a particular site, please assign 0.</p><p>4 More information about the community stations is available via: http://blum.ucsd.edu/comsta.html</p><p>Cross-Border Community Station at Casa Familiar (San Ysidro, California) ____ Cross-Border Community Station at Laureles ____ Canyon (Tijuana, BC, Mexico) + the Tijuana River Estuary (Imperial Beach, CA) EarthLab Community Station ____ (Encanto, San Diego, California)</p><p>Spanish proficiency</p><p>How would you rank your Spanish proficiency? (Refer to https://en.wikipedia.org/wiki/ILR_scale)</p><p>0 = No 1 = Elementary 3-Limited Working 4-Professional 5-Full 6-Native or Profici Profici Proficienc Working Professi Bilingual ency ency y Proficienc onal Proficienc</p><p>Questions / Concerns / Comments</p><p>Please detail any concerns and questions you may have</p><p>5</p>