Purposeful Pathways GAP Program Application for Fall 2022

Applications will be reviewed and students will be admitted to the program in the order in which they are received. Space is limited; therefore, students are encouraged to submit applications as soon as possible.

You are unable to save and return to this application; it must be completed in one sitting. Since there are a few short answer responses requested below, we encourage you to review them and draft your replies prior to filling out this application.

All fields marked with an asterisk (*) are required.

Name

First Name *

Middle Name

Last Name *

Preferred Name/Nickname (e.g., "Jimmy" instead of "James" or "Maggie" instead of "Margaret")

Have you used any name in the past other than your current legal name?

Former First Name *

Former Last Name *

Contact Information

Email Address *

NOTE: Please supply a personal email address (e.g. Gmail, Yahoo, etc.) rather than a school-issued email address.

Phone *

Phone Type *

Permanent (Home) Address *

Country

Street

City

Region

Postal Code

Biographical Information

Birthdate *

Legal Sex *

Gender Identity

Your gender *

Personal Pronouns *

Your pronouns *

Are you a U.S. citizen or permanent resident? *

Social Security Number (please omit dashes) *

Please note that we are unable to process any application without a Social Security Number. The federal government requires that we include Social Security Numbers for 1098T reporting.

Since you indicated that you are not a U.S. citizen or permanent resident, please identify your primary country of citizenship. *

Please choose the response below that best describes the highest educational level attained by your parent(s). *

Academic History

Please note that a high school diploma is required prior to beginning this program.

Which of the following best describes your level of academic achievement? *

High School Graduation Year *

Name of Your Current or Most Recently Attended School *

Begin typing to see a list of schools, and then click on your institution's name to populate the field.

Your Academic Class Standing in College *

Approximate Number of College Credits Earned *

College Major(s) *

GPA *

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Relationship to Applicant *

Parent/Guardian Email Address *

Passport Information

Do you already have a passport?

Since there is an international component to this program, you will be required to obtain a passport before departure.

Citizenship (Country) *

Passport Number *

Passport Issue Date *

Passport Expiration Date *

Please upload a photo/scanned copy of your passport.

Short Answer Essays

Please answer each of the questions below. Responses should generally be 100-200 words each, although there is no limit.

Short Answer #1: What attracted you to apply for the Purposeful Pathways GAP Program? *

Short Answer #2: What do you hope to achieve by participating in the Purposeful Pathways GAP Program? *

Short Answer #3: Please share three (3) things that you hope to learn from your participation in the Purposeful Pathways GAP Program. *

Recommendation

We require one recommendation from a high school counselor, teacher, coach, school administrator, or academic advisor. Please provide their name and contact information below. An automatic email will be sent to them upon submission of this application with a link to the recommendation form.

Recommender's First Name *

Recommender's Last Name *

Recommender's Relationship to Applicant (e.g., teacher, counselor, advisor)

Recommender's Email Address *

Financial Assistance

We have limited opportunities to partially defray the cost of the Purposeful Pathway GAP Program for eligible students. Applications for financial assistance will be considered on a first-come, first-served basis, and will be based on income eligibility as well as the quality of short answer essay responses above. To apply, you will need to upload documentation of eligibility for a Free/Reduced Lunch Program, a public assistance statement, or proof of parent's income such as the IRS 1040, 1040NR, 1040EZ, SSI, or SSDI for the 2020 or 2021 tax year.

Would you like to apply for financial assistance?

Please upload documentation of eligibility for a free or reduced lunch program, a public assistance statement, or proof of parent's income through the IRS 1040, 1040NR, 1040EZ, SSI, or SSDI. *

Certification Statement

I understand that submitting an application for the Purposeful Pathways GAP Program through Carlow University does not guarantee acceptance into the program. Admission to the program is rolling and therefore applications will be reviewed and students will be admitted to the program as applications are received. Students are encouraged to submit applications prior to the deadline. Candidates must meet program requirements and be approved by the program's faculty coordinator. Participation is also subject to availability.

I further understand that the program or individual courses may be cancelled due to low enrollment or other factors and I understand that I will be informed of such a decision no later than eight (8) weeks before program start date or as soon as possible after any adverse circumstances cause the program to be cancelled.

I understand that I must complete the Study Abroad Policy documentation before being fully admitted into the program.

In lieu of a signature, please type your full name below. *

Today's Date *

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Purposeful Pathways GAP Program Application for Fall 2022