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LEARNING JOURNEY

APPLICATION FORM

Contents

Part One: Introduction Page 2

Part Two: Personal Information Page 3

Part Third: Applications Questions Page 4

Part Four: References Page 7

Part Five: Scholarship Questions Page 8

Part Six: Disclaimer and Signature Page 9

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PART 1: Introduction

A. Instructions & Guidelines

Please fill out this application thoroughly and thoughtfully. You will need Microsoft Word to view and fillout this form.

Once you have completed the application in its entirety, save the file, then you may print a copy foryour records, and send a copy of the final version to nishma@connectindia.org. Successful applicants willbe 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 beconsidered. 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, finalparticipants will need to pay the programme price of 850 by cheque or transfer. Please note that astudent discount of 15% will be available on the progamme price, for which valid proof will be requestedprior 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 theapplication process.

C. Application Deadline

23:59 on Thursday 22 May 2014.

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For more information:www.connectindia.org| For help:nishma@connectindia.org

PART 2: Personal Information

Personal Details

SurnameTitle

First

Name

Date of

Birth

Gender

Contact Details

TelephoneMobile

Email

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)

http://www.connectindia.org/http://www.connectindia.org/http://www.connectindia.org/mailto:nishma@connectindia.orgmailto:nishma@connectindia.orgmailto:nishma@connectindia.orgmailto:nishma@connectindia.orghttp://www.connectindia.org/

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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 theexperience? 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

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Community Involvement

4. In what ways have you been involved in your community? (For example, this can includeexamples from your college, university or workplace). Briefly describe the activities, your role, andwhat 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

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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.

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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 inaddition to this form. References may be contacted upon receipt of application, so be sure to providecurrent information.

Reference 1

Full Name Relationship

Address Email

Telephone Mobile

Reference 2

Full Name Relationship

Address Email

Telephone Mobile

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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 youwould like to apply, please answer the following questions and please specify whether you are applyingfor 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

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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 ormisleading information in my application or interview may result in my release.

Signature

Print Name

Date