Community Outreach


Urban Semester Program Application - Fall 2013

* Required information
Full Name: *
Student i.d. #: *
BW email address: *
Phone # including area code: *
Year at BW: *
Gender: *
Campus or local address if commuter: *
Hometown: *
Major: *
Minor: *
Do you have a car on campus? *
Are you certified to drive the BW vans?
Cumulative Grade Point Average: *
Why are you interested in participating in the Urban Semester Program? Please be specific.: *
What experiences do you have formally (classroom, job, internship, volunteering, etc.) and informally (i.e. life experiences) that you believe will make you a good candidate for this program? *
Give a sense of how others may see you in a group experience. Talk about your interpersonal skills and your strengths and weaknesses.: *
What impact do you anticipate having on the program overall (i.e. courses, living situation, internship, etc.)? *
What impact do you anticipate this experience will have on you? *
Please list two BW references. Include their name, title, email address and phone number.: *
How did you find out about the Urban Semester Program? Please check all that apply.:  friend    RA    Info. session    flyers    faculty member    campus bulletin    other  
Serious violations or multiple violations of college policy may jeopardize your eligibility for participation. The Director will check student conduct records through the Office of Residence Life. Students are expected to be in good academic standing as well. The Director will check cumulative grade point averages. The judgment of the Urban Semester staff on this matter will be final. Information acquired will remain confidential and will be used for official use only.
I hereby give my consent for the Director to check my records as indicated in the above statement.: *
It is imperative that you check the times that you are available for a 20-minute interview. Please note that flexibility is essential. Thank you for your cooperation.
Interview Availability - please check times you are AVAILABLE:  1/29 – 12:00 p.m.    1/29 – 12:20 p.m.    1/29 – 12:40 p.m.    1/30 – 2:00 p.m.    1/30 – 2:20 p.m.    1/30 – 2:40 p.m.    1/30 – 3:00 p.m.    1/30 – 3:20 p.m.    1/30 – 3:40 p.m.  
Completed applications must be submitted by 5:00 p.m. on Tuesday, January 15, 2013.
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