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Qualtrics Survey Software 9/4/18, 10)56 AM Carolina Global Initiative Award Application 2018-19 SUMMARY Title: The Carolina Global Initiative Award 2018-19 Rolling Deadline Eligibility: Degree-seeking students at any level, except domestic Ph.D. candidates Program Contact: Brandy Arellano https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 1 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM Contact Information 2018-19 CONTACT INFORMATION First Name: Last Name: Permanent Home Address: Address Line 2: City: State: Zip: Phone: UNC Email: Permanent Email: UNC PID: UNC Onyen: Affiliation Anticipated year of graduation Major Second major https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 2 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM Minor FINANCIAL NEED DETERMINATION Financial need is a factor considered in the selection process. You must demonstrate financial need in one of the following three ways. Please select the most appropriate options and provide supporting documentation, if applicable. By answering this question, you are allowing us to verify your financial aid status with the Office of Scholarships and Student Aid. I have applied for financial aid and qualify for need-based financial aid at UNC. I am an international student with financial need. Complete and upload the International Student Financial Aid Need Worksheet. I do not qualify for need-based 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 complete a global opportunity. The more specific you can be, the better we will be able to understand your financial situation, so please include as many concrete details as possible. Financial Need Statement Please provide supporting financial documentation, if applicable. Are you a designated Carolina Covenant or Achieve Carolina student? https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 3 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM PAST TRAVEL Priority is given to applicants with limited or no global travel. Please indicate the total time, in days, you have spent outside of the United States or your birth country. (If you are an international student, do not include the time you have spent in the United States.) Please provide details for all the time you spent outside of the U.S. and/or your birth country. If none, please leave blank. If you are unsure of the specific dates, please provide your best estimate. Dates Description of Travel Location(s) ex: 02/2012-04/2012 Family Vacation Mexico City, Mexico 1 2 3 If you have additional experience that does not fit above, or wish to further explain your past experience, please enter it below. SUMMARY OF PROJECT OR PROGRAM Please provide a title for your proposal and a brief summary. This information will be used to identify your proposal and for media and publicity purposes if your project is funded. Title (maximum 150 characters) https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 4 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM Summary Description (maximum 400 characters) Please provide a 1-2 sentence summary in THIRD PERSON, PAST TENSE of your proposal. Please include your name, country of travel, and a plain language summary of your proposed project, internship, or research. We will use this summary on our website as well as possible promotion through UNC Communications and/or UNC Development. Example: CeeGee Eye traveled to Johannesburg, South Africa to intern with a local organization and explore African business, culture and local economics. She worked with local business leaders to learn about their approaches to marketing and growth strategy. Academic Credit Will you be receiving any academic credit for this global experience? NOTE: We are no longer considering applications for programs that offer academic credit. Students can use financial aid and search for other funding using the Funding Finder. If you plan to retroactively receive academic credit after the experience, we will consider your application. Yes, I will receive academic credit. No, I will not receive academic credit. Other, please explain. LOCATION & PROJECT DATES Project/Travel Location Please select all of the countries to which you will travel for this project. If the project occurs domestically, please select "United States." (Hold CTRL to select multiple items) https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 5 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Project Focus Locations Please select all of the countries that your project focuses on. This may or may not be the same as your country of travel. (Hold CTRL to select multiple items) Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Please indicate the time of year your project will occur. Select one. Fall break Winter break Spring break Summer Other Proposed Start Date (mm/dd/yy): Proposed End Date (mm/dd/yy): https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 6 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM Are there any important dates of which the program manager should be aware? (i.e. payment deadlines or deposit due dates) SHORT ANSWER QUESTIONS Please complete the questions below. We recommend you write them in a separate document, then copy and paste them into the boxes. Be sure to consider the evaluation criteria as you answer the following questions. If you have questions at any time during the application process, please feel free to contact the program manager at: brandy_arellano@unc.edu. Opportunity Description Describe your proposed opportunity. Include a description of the type of work, research or study you’ll undertake as well as the organization(s) with which you will work. (maximum 350 words) Timeline Provide a general timeline of your proposed opportunity. The timeline should communicate when you’ll start activities and the different https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 7 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM phases of the project or opportunity. See timeline examples. Connection to Academic and Career Goals Explain how completing this opportunity aligns with your past and future studies as well as your career goals. (maximum 250 words) Personal Narrative and Diversity of Approach Tell us your story! Please discuss the unique background, perspective and personal experience you will bring to this opportunity. (maximum 250 words) https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 8 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM BUDGET Please detail your budget below, and be as specific as possible. For guidance on creating your budget, please see our resource, "Travel Application Tips." Item Description/Explanation Amount (In US Dollars) ex: Airfare RDU to London, UK 1130.00 1 2 3 4 5 6 7 8 Line-Item Budget Total Total Funding Requested Budget Justification (optional) Please provide any budget comments, justifications, or additional line items that do not fit in the budget matrix. If there is a difference between the Line-Item Budget Total and the Total Funding Requested, please explain. https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 9 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM ADDITIONAL FUNDING Please provide information on other funding you have received, applied for, or that you plan to apply for in support of your project. Additional Funding Details Amount Organization/Department Description/Additional Information (In US Status Dollars) ex: Honors Carolina BURCH Fellowship $1000 1 2 3 4 5 6 7 8 SUPPLEMENTAL MATERIALS Please provide supplemental material relevant to your application (if applicable). ex: Letter of Affiliation https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 10 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM REFERENCE No letter of recommendation is required for this application, but we ask that you provide the name and contact information of one individual who knows you well (excluding family members). The review committee may contact your reference if they have further questions about your application. This person may be a current faculty member, a mentor or a high school teacher who knows you well. Reference Name Reference Email Reference Phone For how long and in what way have you known the reference? OPENING ACCESS BACKGROUND INFORMATION This concludes the portion of your application that will be visible to reviewers. You are required to complete the following section to complete your application, but none of the responses will be visible to the review committee and will not be used to evaluate your application. Instead, this data will be analyzed in aggregate form by program staff to develop global opportunities for all Carolina students. This pan-university Opening Access effort is designed to ensure all students can access global experiences regardless of their academic discipline, age, disabilities, educational or family background, gender identity, racial or ethnic identity, sexual orientation or socio-economic status. Please indicate the race/ethnicity with which you identify (mark one or more box). https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 11 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM 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 https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 12 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM Not listed above NC Residency Status: Please indicate if you transferred to UNC-Chapel 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. https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 13 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM 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 student-athlete 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 https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 14 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM 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. Select any of the barriers listed below that have kept you from participating in global opportunities abroad. Academic course requirements Lack of administrative support Didn't know about opportunities Applied for programs but was not accepted Worried I wouldn't graduate on time Did not have the funds to participate Faced the burden of lost working wages Lack of support, encouragement or understanding from family members Didn't see the value of global travel Didn't see myself as the kind of student who could travel abroad Lack of peer support Other, please describe Provide a specific example of a barrier you faced. (Optional) Please indicate all of the ways you heard about this particular award. CGI website CGI Facebook CGI Twitter https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 15 of 16
Qualtrics Survey Software 9/4/18, 10)56 AM CGI eBulletin Flyer around campus Bus ad Embark Website From a colleague or professor Met CGI staff Other/not-listed (please indicate below) Please identify the social networks on which you generally engage with (read content, comment or like content, retweet, etc.). Facebook Twitter Instagram LinkedIn None Other Powered by Qualtrics https://unc.az1.qualtrics.com/WRQualtricsControlPanel/Ajax.php?action=GetSurveyPrintPreview Page 16 of 16
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