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100,000 Strong Initiative
2017 Study in China Scholarship Application sponsored by
Wanxiang America Corporation
Thank you for your interest in applying for this exciting study in China experience. For four weeks in Summer 2017, students will study Chinese language, culture and clean energy science at Wanxiang Polytechnic in Hangzhou, China. Students will be given the opportunity to visit variouscultural sites in China during this once-in-a-lifetime opportunity.
Students will be expected to obtain their own passport and provide their own personal spending monies for the trip. All other expenses, such as your tourist visa to enter China, round trip airfare, transportation throughout China, all room and board in China, academic curriculum at Wanxiang Polytechnic plus other incidental expenses are made possible by the generous gift from Wanxiang America Corporation.
Please carefully review the eligibility and application requirements. Your application materials must be submitted to the contact information below by Friday, March 10, 2017 at 5:00 p.m.
Shelly L. Maharry MPA, CGW
Associate Director, Community Foundation of Greater Muscatine
Chair, Muscatine China Initiatives Scholarship Committee
208 W. 2nd Street, Ste 213, Muscatine, Iowa 52761
Email:
Phone: 563-264-3863
You are eligible for this opportunity if you meet the following criteria:You are student in 9th, 10th, 11th or 12th grade at Muscatine High School as of June 1, 2017
-or- / You are currently in 12th grade at Muscatine High School - Graduating in May 2017
-or / You are an enrolled student at Muscatine Community College residing within Muscatine County
You have a cumulative GPA of 2.75or higher for Muscatine High School Students
-or- / You have a cumulative GPA of 2.50 or higher for Muscatine Community College Students
You must be able to travel to China for 4 weeks in summer 2017 (exact dates to be determined)
You have a sincere desire to study Chinese language, culture and clean energy science
Your application materials will include the following:
A completed application form
A personal essay
A scanned copy of your current passport (if you will be in the process of applying for a passport, please note that in the application)
Complete One “Study in China Teacher/Faculty Recommendation Form”
Submit a 2 minute video of yourself describing why you should be selected as a scholarship recipient
Applicant Information
First Name:
Middle Name:
Last Name:
Gender:
Date of Birth:
MHS Student (Grade as of 6/1/17):
MCC Student (credit hours complete as of 6/1/17)
Address Information
Permanent Address
Street Address:
City, State, Zip:
Email Address
School Email Address:
Alternate Email Address:
Do you permit CFGM to give your email address to other students participating in the program: Yes No
Primary Parent/Guardian Information (For Students Under 18)
First Name:
Last Name:
Street Address:
City, State, Zip:
Phone Number:
Place of Employment:
Work Number:
Email Address:
Applicant Phone Contact Information
Home Phone:
Cell Phone:
Academic Information
MHS Student
Cumulative GPA:
MCC Student
Major/Minor:
Current Cumulative GPA:
Expected Graduation Date:
Emergency Contacts
Please list persons available 24/7 for contact during your travel dates. At least one emergency contact must have authority to make medical decisions on your behalf.
Contact #1
First Name:
Last Name:
Relationship:
Street Address:
City, State, Zip:
Daytime Phone:
Evening Phone:
Contact #2
First Name:
Last Name:
Relationship:
Street Address:
City, State, Zip:
Daytime Phone:
Evening Phone:
Dietary and Medical Information
Please list any special medical conditions (This information is required for emergency situations only. All information will be kept confidential):
Studying in another country requires considerable adaptability. This is both part of the challenge and the regard. Your willingness to answer these questions may assist us in organizing a successful program.
Please answer the questions below to the best of your knowledge / YES / NOTraveling abroad requires a great deal of physical mobility. Do you have any physical limitations or disabilities?
Are you generally in good physical condition?
Do you have any pre-existing medical conditions?
Have you ever had any major surgical operations or advised to have one?
Have you ever been hospitalized?
Have you received any treatment for drug or alcohol addiction?
Are you a diabetic?
Do you have any kind of heart condition?
Have you ever been treated for any mental health condition?
Do you have any allergies to food, medications, environmental factors, animals, insects, etc..?
Are you currently taking any medications?
Do you have any dietary restrictions? (Not all restrictions may be accommodated depending on the limitations of the local food supply.
If you answered yes to any of the questions above, please explain below:
I certify that all responses made on this medical report are true and accurate to the best of my knowledge, and I will notify Community Foundation of Greater Muscatine (CFGM) hereafter of any relevant changes in my health occur prior to the start of the program. I understand this form is for information purposes only, and in no way implies CFGM takes responsibility for my health.
Student Signature: Date:
Parent/Guardian Signature: (if applicable) Date:
Important information about passports
If you need a new passport or need to renew an existing one, we strongly encourage you to apply now. Currently, an average wait time for any new passport is about 6 weeks. Students will be required to obtain their own passport. To apply for a passport, visit the Muscatine Post Office located at 3100 Cedar St.
If you already have a passport, please provide your passport information below:
Do you have a valid US passport?
If yes, what is your passport number?
Passport expiration date:
Please attach a copy of your valid passport in the space below.
Personal Essay
Please answer the following question in a clear, thoughtfully prepared short essay (250 – 300 words)
Wanxiang Group offers the opportunity to immerse yourself in the Chinese culture. However, it is your responsibility to make the most of this experience. Introduce yourself and explain your academic goals for studying and for integrating into the Chinese culture. What specific situations from your past (i.e., coursework, job experience, travel, intercultural experience, school programs) have helped you prepare to accomplish these goals?
Submit a Two Minute Video – Uploaded to YouTube
As part of your application, we require you to submit a short video. The purpose of this video is to allow the selection committee to get to know you better. We want to hear from you, in your own words, why you should be selected for this once-in-a-lifetime opportunity. Tell us how you believe this experience will impact you now and in the future. This is your opportunity to let your personality shine, far better than a simple paper application. If selected, you will be acting as an ambassador of Muscatine and the State of Iowa. Your video should convey your understanding of the special role you and the other selected scholarship recipients will have during your visit.
Please upload your video to YouTube and send a link by email to Shelly Maharry () by the application deadline.
100,000 Strong Initiative
2017 Study in China Teacher/Faculty Recommendation Form
Name of Student:
To be Completed by Teacher/Faculty Member
How long and in what capacity do you know the Applicant?
Current Student of Mine Previous Student of Mine Other
According to the following criteria, how would you evaluate the applicant’s readiness for study in China?
Unable to Evaluate / Low / Acceptable / Very Good / ExcellentMotivation for study abroad
Academic performance
Emotional stability and maturity
Respect for customs, rules and values of others
Ability to handle stress
Flexibility
Self-reliance and independence
I recommend this applicant without reservation
I recommend this applicant with reservation
I do not recommend this applicant
Please explain your recommendation:
Printed Name of Teacher/Faculty: Date:
Signature of Teacher/Faculty: