Alexander WildLab at Virginia Tech and CARACAL Learning Opportunity Application

Alexander WildLab and Virginia Tech Study Abroad Application

Deadline: October 29, 2019 at 11:59 pm eastern time.
Read all information about the program here carefully prior to submitting your application. All applicants will be notified of status by December 31st, 2018. Five students will be chosen to participate. All applicants will have the option to be placed on a waitlist should a position become available.
Read and Understand the instructions. *

Yes, I have
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalization and punctuation.
I. General Information

Tell us about you!
Full Name *

First Name Middle Name Last Name
Birthdate: *

Month Day Year
Mobile No. : *

Area Code Phone Number
E-mail : *
Where the confirmation will be send to

Home Address : *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Eligibility Information

This learning opportunity is being offered to American minority students who are underrepresented in the science, technology, engineering, and mathematics (S.T.E.M.) feilds. The following information will be useful in determining elibigibity.
Are you a US citizen?

Yes No
Were you born outside the USA?

Yes No
If so, what country?
Were your parents born outside the USA?

Yes No
If so, what country?
Race? (Choose one or more): *

Caucasian (Non-Hispanic) Black or African American Asian American Indian or Alaskan Native Hawaiian or Other Pacific Islander Hispanic Prefer not to disclose (Please know that this is minority focused program)
Are you planning on applying to college?

Yes No
Following high school graduation, do you have any interest in attending Virginia Tech?

Yes No
Are you interested and willing to major in Science, Technology, Engineering (Engineering) or Math?

Yes No
Will you be a first generation college student?

Yes, I am the first among my parents or grandparents to attend college. No, either my parents or grandparents have attended college.
Major Area of Interest
Please indicate what is your major are of study
II. High School Information:

This opportunity is for junior and senior students at Louisa County High School or Louisa County Residents and Relatives within the requirements.
What year are you currently during the 2019-2020 school year?

Freshman Sophomore Junior Senior
May/June 2019 high school graduates are eligible for consideration for this learning opportunity.
High School Attending:
If you answered other to High School Attending, Please list the high school here and relation to Louisa County High School.
High school activities, community activities, volunteer work, honors, leadership roles held:
Most recent cumulative GPA:
Is this GPA weighted?

Yes No
Have you ever participated in a study abroad program?

Yes No
III. Medical/Health Requirements Information

There are certain vaccines and heath standards suggested for travel to Botswana. The follow questions reflect some of the CDC health concerns or suggestions. Feel free to visit the CDC website referenced for more information. However none of your answers to the following question will be used for your consideration. https://wwwnc.cdc.gov/travel/destinations/traveler/none/botswana
Do you have a disability that may require accommodations while traveling?

Yes No Prefer not to disclose
Are you on any medications that may require accommodations when traveling? (Please Explain)
This question is optional and all information provided was done so at will of the applicant. This question will not be used as a limiting factor in the application review.
Are there any listed vaccines that you are hesitant to receive for reasons other than medical exemptions?

MMR Diphtheria-Tetanus-Pertussis (DTap/Tdap) Varicella (Chickenpox) Hepatitis A Hepatitis B Flu Vaccine Polio Vaccine (IPV)
Could you currently be pregnant?

Yes No Prefer not to disclose
IV. Essay
Your essay should be 300-500 words. You should address in your essay: what about you makes you a great candidate for this opportunity, what life experiences you've had that made you who you are today, and what you plan to do with the information you learn on this trip. Let us know what makes you YOU!
Essay:

0/500
V. Situational Perspectives

Below is a list of scenarios that may occur while in Botswana. Please respond in as few sentences as possible how you may react to the scenario.
Are you able to go 24-48 hours without WIFI?
You'll find a wide variety of insects in Botswana. Would this present an issue for you?
CARACAL is known by the locals as the "snake park" as we have a variety of snakes for educational purposes. Are you comfortable around caged snakes and reptiles?
The Chobe District is known for our vast wildlife. Are you comfortable being around and working with wild animals and dogs?
Are you able to adapt to last minute change of plans?
Have you ever found yourself needing to remain calm during a stressful situation? Can you explain?
Are you comfortable around children?
Do you enjoy trying new foods? (Specifically meats)
Are you comfortable speaking to foreigners?
Power outages are common in Kasane. How do you deal with power outages?
V. Parent/Guardian Information
Parent/Guardian 1 Name: *

First Name Last Name
Parent/Guardian 1 Phone Number *

Area Code Phone Number
Parent/Guardian 1 Email *
example@example.com
Parent/Guardian 2 Name

First Name Last Name
Parent/Guardian 2 Phone Number

Area Code Phone Number
Parent/Guardian 2 Email
example@example.com
VI. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature of minor: *
Date *

Month Day Year
Date Date Picker Icon
E-Signature of Parent or Guardian *
Date *

Month Day Year
Date Date Picker Icon
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Alexander WildLab and Virginia Tech Study Abroad Application

I. General Information

II. High School Information:

III. Medical/Health Requirements Information

IV. Essay

V. Situational Perspectives

V. Parent/Guardian Information

VI. Applicant's E-Signature