Apply for Fulbright U.S. Student Program 2018-2019 Interest Form

Please fill out the form below and click Submit to submit your application for consideration. You may save your data and return later to complete your application. Fields with an asterisk (*) are required.

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Summary
Title:Fulbright U.S. Student Program 2018-2019 Interest Form
ID:FUSP 2017
Deadline:09/18/2017
Eligibility:Graduating seniors, grad students, and alumni who can attend an on campus interview
Program Contact:Iyman Gaspard
Contact Information
* First Name:
* Last Name:
* Permanent Home Address:
Address Line 2:
* City:
* State:
* Zip:
If NC, enter county:
* Country:
* Phone:
* UNC Email:
If you are not affiliated with UNC, you may enter your personal email.
* Permanent Email:
Please enter an alternate, non-UNC email address.
UNC Campus Box:
* UNC PID:
Enter your UNC PID without hyphens or spaces. If you are not affiliated with UNC, please enter a "0" in the field.
* UNC Onyen:
If you are not affiliated with UNC, please enter "n/a."
Affiliation:
Department:
If you are a student, please select the department of your primary major.
* Major/Field of Study:
Second Major/Field of Study:
Fulbright Program Interest Form
Please answer the following questions to help with the advising process. You are not committing to a particular country or program with this submission, but rather providing information to help the adviser. Your answers will not be part of your application, nor viewed by review committee members.

NOTE: THIS IS NOT THE OFFICIAL FULBRIGHT APPLICATION! YOU MUST STILL COMPLETE THE APPLICATION AVAILABLE AT http://us.fulbrightonline.org

MORE INFORMATION ABOUT THE PROCESS AT UNC IS AVAILABLE AT THIS LINK.

* Planned country of application (you may list multiple if undecided):

* Type of Program(s) Interested in

  
  

* If Academic or Creative Arts, in which Fulbright field do you think will you apply?

* Brief summary of past relevant experience or travel:

List any languages you have studied or know along with a generalized rating of your ability level (ex: elementary, conversational, fluent, etc.):

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 pan-university effort to significantly increase the number of traditionally underserved students who have access to global opportunities.

For the purposes of this Initiative, we use the following definition of “global opportunities”: 1) educational opportunities abroad (study abroad, research, service-learning, internship, work); 2) global opportunities on campus (including course work in foreign languages, events and co-curricular student activities); 3) globally-oriented service in the community (engagement with K-12 classrooms or immigrant communities).

Throughout the 2017-2018 academic year, we are collecting data to support programing of new initiatives to open access and we need your help.

Your answers to this section WILL NOT be seen by review committees. Your responses will not be used for evaluating your application. Your responses will be analyzed in aggregate form by program staff to develop global opportunities to address barriers to participation.

* 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
Some Other Race -- Print race in space below

* Please indicate the gender with which you identify

Female
Male
Prefer not to answer
Not listed - please indicate below

* Please indicate the sexual orientation with which you identify:

Bisexual
Gay or lesbian
Heterosexual or straight
Prefer not to answer
Not listed - please indicate below

* Please indicate your religious identification (mark one or more box):

Agnostic
Atheist
Buddhist
Hindu
Jewish
Mormon
Muslim
None
Orthodox
Protestant
Roman Catholic
Prefer not to answer
Not listed - please indicate below
Date of Birth:
*
*
*
  • * Please indicate your citizenship status
    International student
    Permanent resident/green-card holder
    US citizen (naturalized)
    US citizen (natural-born)
    Prefer not to answer
  • * Please indicate your birth city and state (if in the U.S.) or the country (if abroad):
  • * Please indicate the birth city and state (if in the U.S.) or the country (if abroad) of your parent/guardian 1:
  • Please indicate the birth city and state (if in the U.S.) or the country (if abroad) of your parent/guardian 2:

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

Blind/Visual Impairment
Chronic Medical
Deaf/Hard of Hearing
Learning Disability
Physical/Mobility impairment
Psychological
No disability/impairment
Not listed - please indicate below
Prefer not to answer

Student Status

Please read the following and indicate if you are a dependent or an independent student:

Independent Students are any one of these:

Dependent Students are typically undergraduates who who receive more than one-half of their support from the parent(s) and will continue to receive more than half of their support from the parent during the year.

* Please indicate your student status as defined above:

* NC Residency Status

* Please indicate if you transferred to UNC from another institution:

* Please indicate your partnership/relationship status

Divorced
Domestic partnership
Married or civil union
Separated
Single
Widowed
Prefer not to answer
Not listed above - please indicate below

* 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

* Have you ever enrolled (or led if Faculty/Staff) a formal study abroad program at UNC.  If so, indicate the type(s):

Year-long
Semester
8 weeks or less
None
Led/directed a program (also check type above)

Please indicate the program in which you participated, if applicable:

Please indicate any awards, fellowships, or scholarships you received for a global experience:


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