International Service Learning Application

The International Service Learning Program is an interdisciplinary program. Each student registers and participates in a discipline specific academic course (3 credit hour), interdisciplinary pre-departure seminars (eight 2 1/2 hour sessions) and an international field study. Students do not have to be in a specific academic discipline to apply for the program - with the exception of dentistry students. During the field study (Cebu and/or Belize), students work in all disciplines to provide dental care, workshops in schools, educational sessions for the local community and participate in local cultural activities.

Academic Disciplines for Cebu, Philippines include:

Communications
Dentistry
Education

Academic Disciplines for Red Bank, Belize include:

Communications
Dentistry
Education
Expressive Therapy
Justice Administration

Academic Disciplines for Botswana, Africa:

Communications
Education
Justice Administration
Psychology

Your completed application and one academic reference must be submitted as follow:

Cebu - July 28, 2009 - APPLICATION CLOSED

Belize - Priority Deadline is October 1, 2009

Botswana, Africa - TBA

General Information

Please Select One of the Following Participation Options (Required)

Red Bank, Belize (March 12-19, 2010)
Botswana, Africa (April 28, 2010 - May 7, 2010)

Department First Choice

Department Second Choice

Name:

Student ID #:

Your E-Mail Address (Required)

Gender:

Male
Female

Birth Date:

Land Phone #:

Cell Phone #:

Citizen of:

Ethnicity

Address1

City:

Address2

State:

Zip Code:

Status

Status Other:

Do you have a current passport?

Yes
No

If so, what is the expiration date?

/ /

Please List the Languages Spoken and Level of Proficiency for Each

Extracurricular Activities

International Experience, Study or Travel - Please lists places, purpose, and dates.

What do you expect to learn by participating in the ISL Program?

How did you learn about ISL?

Why Are You Interested in the International Service Learning Program?

Define Service Learning. What Does it Mean to You?

Please Describe Previous Leadership, Travel and/or Service Experiences that May be Similar to the ISL Program.

Have you Ever Been Charged or Convicted of a Crime? Please Explain.

Do You Have any Medical or Psychological Condition That Would Affect Your Participation in the program? Please Explain

Authorization (Required)

I authorize the University of Louisville International Service Learning Program staff to access my educational and financial records maintained by the University of Louisville or other intuitions I have attended and to share those records with the IISL Program Coordinators as needed.

Certificate (Required)

I certify that the information I provided on this Application is correct and agree to notify the ISL Program if there is a change in circumstances which might compromise my success in participating in the ISL Program.

Waiver (Required)

Under the provisions of the Family Educational Rights and Privacy Act of 1974, I waive my right of access to my ISL Academic Reference

Your completed application and one academic reference must be submitted as follow:

Cebu - July 28, 2009 - APPLICATION CLOSED

Belize - Priority Deadline is October 1, 2009

Botswana, Africa - TBA

Direct questions to islp@louisville.edu

Please select the "Submit Application" button now to send your application to us. Print the success page if you would like to have a copy of the completed application.

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International Service Learning Application

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