Global Experience Program Application (South Africa)

Orange River and Cape TownMarch 4 to 21, 2010

Student Name: __________________________________________________________________________________________________

First Name Family Name Preferred Name

Date of Birth: _______________________________________________ Age:____________ _______Grade: ____________

Day/Month/Year

Address: _________________________________________________________________________________________________________

Boarder Day Girl

Parents’ Names:

Mother: _________________________________Father:

Guardian’s Name (if boarder): __________________________________________________

List five adjectives that describe you: _________________________________________________________

_______________________________________________________________________________________________

What are your favourite subjects? ____________________________________________________________

_______________________________________________________________________________________________

Do you belong to any clubs or sports teams? _________________________________________________

_______________________________________________________________________________________________

Leadership experience (inside or outside of Havergal): ________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

2

Community outreach experience (inside or outside of Havergal):__________________________________________

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Activities you enjoy: __________________________________________________________________________________________

____________________________________________________________________________________________________________________

1) Please use the space below to explain what motivated you to apply for the Global Experience Program. What do you hope to gain or learn from this opportunity?

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

a) What experience do you have in working with children?

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

b) What did you gain from these experiences?

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________

2) How will you be a good ambassador for Havergal College while in South Africa? What is the role of an ambassador?

__________________________________________________________________________________________________________________________

3

__________________________________________________________________________________________________________________________

3) Please describe any previous international travel experience you may have had. What have you found meaningful about travelling?

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

4

4) How flexible and adaptable are you in a foreign environment? Please provide a specific example.

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

5) What challenges do you think you may have to face on this experience?

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

7) How will you prepare yourself for this experience?

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

8) In your opinion, why should you be chosen for this opportunity?

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

Student signature: ________________________________________________________ Date: ___________________________

I support my daughter's application and understand that her participation in the Global Experience Program involves my daughter being billeted with the family of St. Cyprian’s School. I also understand that this application represents a commitment to the program. We will not withdraw from the program if my daughter is selected, unless exceptional circumstances arise and we have permission from the Principal.

5

Parent/Guardian name: _____________________________________________________(Please print)

Parent/Guardian signature: _____________________________________________________ Date: ___________________________

6