Passport to Go! 2018 19 Application - UNC Center for Global Initiatives

Passport to Go!
                            2018­19 Application

Title: Passport to Go! Program 2018­19

Deadline: 09/30/2018

Eligibility: First­year undergraduate or first­year transfer students who have never had a U.S. passport
and demonstrate financial need. Students must be U.S. citizens in order to be eligible for a U.S.
passport.

Program Contact: Brandy Arellano

 CONTACT INFORMATION
First Name:

Last Name:

Permanent Home Address:

City:

State:

Zip:

Phone:

UNC Email:

Permanent Email:

UNC PID:

UNC Onyen:

Affiliation

From what school did you transfer?

Anticipated year of graduation

Major

Second major

Minor

FINANCIAL NEED DETERMINATION

Financial need is a factor considered in the selection process and must be demonstrated in
one of the following three ways. Please select the most appropriate option, and provide
supporting documentation, if required.
   I have applied for financial aid and qualify for need­based financial aid at UNC.
   If you select this option, you are allowing us to verify your status with the UNC financial aid office.
   I am an international student with financial need.
   This award is only available for U.S. citizens to receive their first U.S. passport. As an international student, you
   are likely ineligible for this award, but please let us know if you believe you are still eligible.
   I do not qualify for need­based aid, nor am I an international student.
   Write and upload a brief (no more than one page) statement about your financial need and why this funding is
   required in order for you to receive your first U.S. passport.

Financial Need Statement

Are you a designated Carolina Covenant or Achieve Carolina student?

 PAST TRAVEL

Have you ever had a U.S. passport?
   No
   Yes ­ If you have had a U.S. passport, you are ineligible for the Passport to GO! program. You can consider
   attending the UNC Global Passport Drive around November 2018 to renew.

Are you a current U.S. citizen and otherwise eligible to apply for U.S. passport?
   No ­ If you are not a U.S. citizen, you are ineligible for a U.S. passport.
   Yes

Have you ever traveled outside of the 50 United States before?
   No
   Yes

If you have traveled outside the U.S., but have never had a U.S. passport, please explain
below.

SHORT ANSWER QUESTIONS

Personal Narrative
Tell us your story! Please discuss your unique background, perspective and personal experience. (maximum 200 words)

Global Goals
Bearing no limitations, where would you go using your passport and why? (maximum 200 words)

OPENING ACCESS BACKGROUND INFORMATION

Aligned with UNC’s Academic Plan, which prioritizes “equity and inclusion” and “global
engagement,” the Center for Global Initiatives is spearheading a major pan­university effort
to significantly increase the number of traditionally underserved students who have access to
global opportunities.

This effort opens access to students regardless of their academic discipline, age, disabilities,
educational or family background, gender identity, racial or ethnic identity, sexual orientation
or socio­economic status.

Please answer the following questions to help us evaluate this effort. Your answers to this
section will not be seen by the review committee and will not be used to evaluate your
application. Your responses will be analyzed in aggregate form by program staff to develop
global opportunities for all Carolina students.

Please indicate the race/ethnicity with which you identify (mark one or more box).

     American Indian or Alaska Native
     Asian
     Black
     Hispanic or Latino/a
     Native Hawaiian or Other Pacific Islander
     White
     Prefer not to answer
     Not listed above

Please indicate the gender with which you identify.

     Male
     Female
     Prefer not to answer
     Not listed above

Please indicate the sexual orientation with which you identify.

     Bisexual
     Gay or lesbian
     Heterosexual or straight
     Prefer not to answer
     Not listed above

Please indicate any of the following impairments or difficulties that may apply to you.

     Visual impairment
     Chronic medical
     Deaf/hard of hearing
     Learning disability
     Physical/mobility impairment
     Psychological
     No disability/impairment
     Prefer not to answer
     Not listed above

NC Residency Status:

Please indicate if you transferred to UNC­Chapel Hill from another institution:

Please indicate your partnership/relationship status.

     Divorced
     Domestic partnership
     Married/civil union
     Separated
     Single
     Widowed
     Prefer not to answer
     Not listed above

Please enter the size of your household (include yourself in the count).

Please indicate the total estimated household income of your family (If a dependent, include your parent(s)/guardian(s), if

independent, include yourself and your spouse/partner, if applicable).

Please indicate the highest level of education either of your parent(s)/guardian(s) have completed.

Please indicate if you have previously traveled outside of the United States (include other North American countries such as

Canada and Mexico, and U.S. Overseas Territories such as Puerto Rico, Guam, etc.).

      Yes
      No
      Prefer not to answer

Please indicate if anyone in your IMMEDIATE FAMILY has previously traveled outside of the United States (include other North

American countries such as Canada and Mexico, and U.S. Overseas Territories such as Puerto Rico, Guam, etc.).

      Yes
      No
      Prefer not to answer

Are you a varsity student-athlete?

(A varsity student­athlete does not include students who play an intramural or club sport.)

      Yes
      No

Which sport do you play?

(Hold the Ctrl button to select multiple sports.)

  Women's Basketball
  Women's Cross Country
  Women's Fencing
  Women's Field Hockey
  Women's Golf
  Women's Gymnastics
  Women's Lacrosse
  Women's Rowing
  Women's Soccer
  Women's Softball

ACCESS TO GLOBAL OPPORTUNITIES

In addition to the demographic information you have provided, we need your feedback regarding barriers you may have

encountered pursuing global opportunities.

Your answers to this section will not be seen by review committees and will not be used to evaluate your application. Your

responses will be analyzed in aggregate form by program staff to develop global opportunities to address barriers to

participation.

Before this program, had you heard about global opportunities?
     Yes
     No

Do you think you will travel abroad during your college career?
       Definitely yes           Probably yes           Might or might not          Probably not             Definitely not

To what extent, if any, do you think the following barriers will prevent you from traveling
abroad?

                                      Definitely will prevent               May prevent                  Will not prevent
Lack of information
Cost
Access to financial aid
Lost wages
Application Process
Peer pressure
Concern about not receiving
credit toward degree
requirements
Fear of missing out
Lack of foreign language
competence
Family resistance
Health/safety/security
concerns
Other barrier

Please indicate all of the ways you heard about this particular award.

     CGI website
     CGI Facebook
     CGI Twitter
     CGI eBulletin
     Flyer around campus

     Bus ad
     Embark Website
     From a colleague or professor
     Met CGI staff
                                                                         Other/not­listed (please indicate below)

Please identify the social networks that you regularly use.

     Facebook
     Twitter
     Instagram
     Vimeo
     LinkedIn
     None
     Other

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