Seminar in Curriculum Development for

International Service-Learning

Application

First Name*

Last Name*

School*

Department*

Position*

Years Held*

Email*

Phone*

Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

How did you hear about this seminar?*

A. Why are you interested in participating in United Planet’s Seminar in Curriculum Development for International Service-Learning?*

B. Please describe any experience you have with international service-learning.*

C. Do you have support from your department head or other relevant approval for this program? Please explain.*

D. How do you plan to implement the learnings from this seminar in the short term and long term?*

Please upload CV*

No File Chosen

File uploads may not work on some mobile devices.

Date/Time

Deposit Information

We require a non-refundable application fee and deposit of $150 for the International Service-Learning Seminar. If you are not accepted into the program, this fee will be refunded to you. If you are accepted into the program, this fee will apply as a payment towards the total seminar fee. If you need to postpone your participation for any reason, we will hold your deposit for one year from the departure date you indicated above to be used towards any United Planet program. After one year, your deposit will be considered a donation to United Planet.

Deposit Amount* $

Name (as appears on credit card)*

First Name

Last Name

Billing Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Credit Card Number

* all transactions processed and secured by Authorize.net