LEADERSHIP /// GSL

GLOBAL SERVICE LEADERSHIP: COSTA RICA 2018-2019

APPLICATION

INSTRUCTIONS

1. Applications for the 2018-2019 Global Service Leadership (GSL) trip to Costa Rica
are due on Wednesday October 31, 2018 by 4:00pm. Completed applications can
be submitted by email to Nicole Amorim, Leadership Development Coordinator, at
namorim@conestogac.on.ca or in the CSI Leadership Office, room 2A100 at Doon.

2. All questions and required information must be complete.

3. Please submit the most recent copy of your transcript and your Fall 2018
timetable with your application.

APPLICANT INFORMATIO N

First Name:
Last Name:
Student Number:
Program of Study:
Year of Program:
Language(s) Spoken:
Nationality, as appears on passport:
Passport expiry date:
Date of Birth (DD/MM/YYYY):
Gender:
Street Address:
City: Province: Postal Code:
Home Phone:
Cell Phone:
Personal Email: Preferred email:
Conestoga Email: Preferred email:

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EMERGENCY CONTACT INFORMATION

First Name:
Last Name:
Relationship:
Street Address:
City: Province: Postal Code:
Home Phone:
Cell Phone:
Work Phone:
Email:

INDIVIDUAL REQUIREME NTS

Special Dietary Requirements

Relevant Medical Conditions and/or Medical History

SKILLS & EXPERIENCE

Are you currently involved in any CSI Leadership opportunities? Select all that apply.
Clubs
International Student Advisory Council
Leadership Ambassador
Student or Campus Rep

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Summarize your previous volunteer experience(s).

Summarize any special skills and qualifications you have acquired from employment,
volunteering, or other activities, including hobbies or sports.

Summarize any experience you have with fundraising.

AVAILABILITY

Please indicate all days/times you would be available for GSL meetings in the Fall semester.
Monday Tuesday Wednesday Thursday
3:00pm–4:30pm 3:00pm–4:30pm 3:00pm–4:30pm 3:00pm–4:30pm
3:30pm–5:00pm 3:30pm–5:00pm 3:30pm–5:00pm 3:30pm–5:00pm
4:00pm–5:30pm 4:00pm–5:30pm 4:00pm–5:30pm 4:00pm–5:30pm
4:30pm–6:00pm 4:30pm–6:00pm 4:30pm–6:00pm 4:30pm–6:00pm
5:00pm–6:30pm 5:00pm–6:30pm 5:00pm–6:30pm 5:00pm–6:30pm
5:30pm–7:00pm 5:30pm–7:00pm 5:30pm–7:00pm 5:30pm–7:00pm
6:00pm–7:30pm 6:00pm–7:30pm 6:00pm–7:30pm 6:00pm–7:30pm

Comments:

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REFERENCE

Please provide one reference, who may be contacted after your interview. This should be a
professional reference, such as a supervisor, instructor or teacher. This should not be a
family member or relative.

First Name:
Last Name:
Relationship:
Phone:
Email:

AGREEMENT AND SIGNAT URE

By submitting this application, I affirm that the facts set forth in it are true and complete. I
understand that if I am accepted, any false statements, omissions, or other
misrepresentations made by me on this application may result in my immediate dismissal.

Full Name (printed):

Signature:

Date:

OUR POLICY

It is the policy of Conestoga Students Inc. to provide equal opportunities without regard to
race, color, religion, national origin, gender, sexual preference, age, or disability.

Thank you for your interest in the GSL trips. Please submit your completed application form
to Nicole Amorim, Leadership Development Coordinator. Applications can be submitted by
email (namorim@conestogac.on.ca) or in the CSI Leadership Office, room 2A100 at Doon.

FOR OFFICE USE ONLY

Received By:

Date Received: Time Received:

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