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Campus Anywhere Application
Thank you for your interest in serving and learning with Campus Anywhere and our global network of community partners.
Please contact the Campus Anywhere office at 412-586-4986 or
volunteer@amizade.org
for any questions.
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* Indicates required question
Participant Name and Academic Information
First Name
*
Your answer
Last Name
*
Your answer
Gender: How do you identify?
*
Man
Woman
Non-binary
Other:
What is your expected graduation year?
*
Your answer
What year do you plan to go? What term?
*
Fall 2021 (September 2021)
Spring 2022 (February 2022)
Summer 2022 (June 2022)
Birthdate
*
mm/dd/yyyy
Your answer
Program Location
*
Where do you want to go?
Bolivia
Ecuador
Italy
Northern Ireland
Pine Ridge
Puerto Rico
What is your year in school?
*
Your answer
What university, college, or institution do you go to?
*
Your answer
What is your cumulative GPA?
*
Your answer
What is your most recent term's GPA?
*
Your answer
What is your major?
*
Your answer
Have you talked with your study abroad office about Campus Anywhere yet?
*
Yes
No
N/A
Other:
Do you speak a language other than English?
*
Yes
No
If yes, which language(s) and what is your proficiency level
Native, Advanced, Intermediate, Novice
Your answer
What is your interest in this program?
*
What made you decide to participate in this program and what are you excited about?
Your answer
What is one thing you want to change about your community and why?
*
Your answer
Share a story about a time you collaborated with someone who is very different from you and what lessons you learned from that experience.
*
Your answer
Email 1
*
Your answer
Email 2
Your answer
Mobile Phone
Your answer
Can we text you?
*
Yes
No
Permanent Address
Street Address
*
Your answer
City
*
Your answer
State/Province
*
Your answer
ZIP/Postal Code
*
Your answer
Country
Your answer
Current Address (if different from above)
Street
Your answer
City
Your answer
State/Province
Your answer
ZIP/Postal Code
Your answer
Country
Your answer
Are you a U.S Resident?
*
Yes
No
If yes, please indicate your Citizenship Status
*
U.S Citizen
Refugee
Non-Immigrant/Other Visa Type
Permanent Resident with Alien
Other:
Country(s) of Citizenship:
*
Your answer
Do you currently have a passport?
*
Please note: If you do not currently have a passport it is your responsibility to apply for a passport and to provide this information to Campus Anywhere as soon as it becomes available in order to participate on an international program.
Yes
No, but I have applied for one
No, I do not currently have one
Date you submitted your application
If you do not have a passport, but have already applied for one
MM
/
DD
/
YYYY
Have you ever been convicted of a crime?
Yes
No
Clear selection
If yes, Please briefly describe the nature of the crime(s), the date and place of conviction, and the legal disposition of the case.
Your answer
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