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Canadian Field Studies in Africa

Program Application Form

Applicants should be aware that their application will be circulated amongst members of the selection committee of professors.

1. General Information
Year applying for:
Name (as is appears on your passport):
Address:
City: / Province/State: / Postal/Zip:
Please be sure that we have a valid telephone number for you during the summer as well as during the fall semester and Christmas holidays.
Telephone (1): / Dates valid:
Telephone (2): / Dates Valid:
E-mail:
Please make sure you check your e-mail account regularly, as this will be the method by which we will most often send information. Please update us with any change to your e-mail address.
Do you have a valid passport?
Date of Birth: / Citizenship:
Passport Number: / Expiry Date:
Name of emergency contact: / Relationship:
Address:
City: / Province/State: / Postal/Zip:
Telephone: / Work:
E-mail:
We will be sending you a plane ticket by courier in early January. Please provide a mailing address for this below. No Post Office boxes, please.
Permanent Address:
City: / Province/State: / Postal/Zip:
Telephone:
2. Education
Current educational institution: / Faculty:
Major: / Minor:
*Year: / Will you be attending the CFSIA in your final year of study?:
*Please indicate your current year of study. For McGill students indicate U0-U3 etc.; for non-McGill students indicate U1-U4 etc..
3. Travel Experience
· If you have traveled outside of North America, please indicate where and when:
· You will be faced sometimes with basic living conditions. Are you prepared to accept the fact that our living conditions will often be very basic (no power, lights, running water, or flushing toilets)?
· Roughly, how much camping experience do you have?
· Do you have any experience traveling, living and working with groups of people?
· List any talents that you have that may contribute to the program (e.g. photography, music, etc):
· List any languages you speak, other than English:
4. Contributions
A. In 200 words or less, describe how you feel this program will contribute to your education:
B. In 200 words or less, explain how your expertise will contribute to the program, outlining your relevant background and experience:
5. Diet and Health
· Do you have any special dietary requirements or restrictions, including vegetarianism/veganism?
· How well can you swim?
· Do you have any serious allergies, or other medical conditions which might bring on sudden illness ?
· Do you have any experience traveling, living and working with groups of people ?
Prior to departure, you will be sent a medical history form to be filled out by your family doctor. Our program doctor will review the form at the beginning of the program.
7. Important Information
There are certain risks involved in participating in any external studies program and certain risks involved in traveling to Africa. While the safety of the students and staff is the primary concern in external studies programs, McGill University, the Canadian Field Studies in Africa Program, or their employees cannot accept any liability for an inability to complete the program, for injury or accidents, or for material losses. Policy guidelines require that successful applicants read a “risk statement” and sign a “waiver of responsibility.”
Successful applicants must attend all orientation and safety lectures. Students must always act in a manner consistent with their own safety and the safety of others.
Students must submit two letters of reference attesting to their character and ability to work within groups. These references may accompany the application or follow under separate cover.
Students are expected to be sensitive to local dress code and customs of Kenya and act in a responsible manner. Since we will be traveling and living together as a group, any behaviour that disrupts the program, infringes on the enjoyment of the program by other students, or compromises the safety of others will not be tolerated. Students who act in an inappropriate manner will be asked to leave the program and given a return ticket home. Successful applicants will be required to read and sign a document outlining appropriate behaviour if they wish to
participate in the program
8. Course Selection
To give us an indication of possible course enrollment, please list courses you would like to take, in order of preference. Upper level courses may require prerequisites and/or permission of the instructor.
1st choice:
2nd choice:
3rd choice:
4th choice:
5th choice:
Alternate:
Be advised that courses may change and/or be filled before your application is accepted. Course selections may, however, be adjusted and finalized in January.

As in the past, unforeseen circumstances related to security, costs, administrative interventions or other factors may lead to itinerary changes or cancellation. In the event of change or cancellation, all non-allocated CFSIA program fees paid to McGill University will be fully refundable, and, where necessary, a letter of support will be given to facilitate late registration in alternative on-campus courses. Neither McGill University nor the CFSIA will assume any liability beyond that for any expenses, loss, or other consequences of program changes or cancellation.

I declare that the information in this form and in the attached supporting documents is true, accurate and complete.

Date: ______Signature: ______

Signature of parent/guardian if student is under 19 years of age: ______

Application components to submit with this form:

· $1000 application deposit

· 1 letter of reference

· A current university transcript

International Students should also include:

· proof of immigration status (notarized copy of passport information)

· proof of secondary school graduation (official transcript)

CFSIA Program Application Page 5