Mitchell application

PART A: GENERAL INFORMATION

Deadline March 9, 2020. This form allows you to work on your application for a 30-day period. You can complete and save sections of the form without submitting them and then return to complete the form and upload files at a later date. If you have questions about any items in this application, contact Karen Hamilton at khamilton@mccs.me.edu.

Name*

First Last

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address at College

Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Phone Number*

Preferred Email*

Enter Email Confirm Email

Birth Date

MM

DD

YYYY

Emergency Contact Name*

First Last

Emergency Contact Phone Number*

Relationship of emergency contact to you*

Do you have health insurance?*

Having health insurance is a requirement of the exchange.

Yes
No

Do you have a valid passport?*

You must have a passport valid for at least six months beyond your expected return to the United States.

Yes
No

Are you a US Citizen?*

Yes
No

If no, of what country are you a citizen?

Have you traveled outside the United States?*

Yes
No

If yes, where? For how long?

If you are selected, list your name as you would like it to appear on the award certificate.*

Students who participate in the exchange receive a monthly stipend of €500 to help cover food and other living expenses. However, each student should have at least $600 available for initial expenses as the first stipend may not be immediately available upon arrival at CIT. In general, students are encouraged to have some funds available to help supplement their monthly stipend. In addition, Ireland requires that student visa holders have proof of sufficient funds to support themselves during their period of study in Ireland. This means that, once in Ireland, each student must deposit approximately $3,000 into an Irish bank account in order to register with the Irish Immigration Service. It is important to note that these funds do not need to remain in the account once the student has registered. If you are selected to participate in the exchange, will you be able to comply with these requirements?*

Yes
No

Which semester would you prefer to attend CIT?*

Fall 2020 Only
Spring 2021 Only
Either Fall 2020 or Spring 2021

PART B: EDUCATIONAL STATUS

If you are a current community college student, answer the next four questions.

I am enrolled as a full-time student at (choose from drop down menu):

I plan to graduate in (month/year)

I will have an associate degree in (program of study)

Current GPA

If you are a community college graduate, answer the next four questions.

Which college did you graduate from? (Choose from drop down menu.)

I graduated in (month/year)

I have an associate degree in (program of study)

Final GPA

PART C: REFERENCES

Your application must include two letters of recommendation. At least one writer should be affiliated with the Maine Community College System and be familiar with your academic ability. At least one writer should recommend you for community service. In addition, we ask that references speak to your maturity, leadership abilities, and readiness to travel and live abroad independently. Reference letters should include the writer's name, contact information, and how long and in what context he or she has known you. List below the individuals who will write a letter of recommendation for you.

First Reference Name*

First Last

Second Reference Name*

First Last

PART D: SIGNATURE

By writing my name and the date below, I certify that the information presented in this application is true and complete.

Name/Date*

PART E: ATTACHMENTS AND CHECKLIST

In addition to completing parts A-D of the application form, the following information must accompany your application. All parts of your application must be received at the Maine Community College System by Monday, March 9, 2020. Please note: Uploaded files are not saved if you choose to save a draft of this application and complete it at a later date. Upload files to the form when you are ready to submit your completed application. All uploaded files must be in Word, PDF, or PNG format.

I. List of Course(s)

Review the courses offered at Cork Institute of Technology at http://courses.cit.ie. Courses at CIT equate to community college programs of study; CIT modules equal our courses. List here one or more courses that interest you and any module of particular interest. Include a brief statement explaining why.

II. Essay

Attach a document (Word, PDF, or PNG format) that describes in 500 words or less why you should be awarded the George J. Mitchell Peace Scholarship. Include 1) your name; 2) how this exchange with Ireland will benefit you personally; 3) how it will contribute to your education or career plans; 4) why and how you feel prepared to live and study in another culture—particularly in Ireland; and 5) how you will use this experience to benefit others through leadership and community service.

III. Resume

Attach your resume. (Word, PDF, or PNG format) It must be complete and up-to-date.

IV. Community Service

List the professional, community, or school activities/organizations you are participating in now or have in the past. Include any offices held.

V. Official Community College Transcript

Upload your transcript here, or have the college send it directly to khamilton@mccs.me.edu for arrival by Monday, March 9, 2020. Uploaded files must be in Word, PDF, or PNG format.

VI. Two Letters of Recommendation

Upload them here or recommenders may email them separately to khamilton@mccs.me.edu for arrival by Monday, March 9, 2020. Uploaded files must be in Word, PDF, or PNG format. At least one writer should be affiliated with the Maine Community College System and be familiar with your academic ability.

File

Phone

This field is for validation purposes and should be left unchanged.

Application for Fall 2020/Spring 2021

PART A: GENERAL INFORMATION

PART B: EDUCATIONAL STATUS

PART C: REFERENCES

PART D: SIGNATURE

PART E: ATTACHMENTS AND CHECKLIST