1. Healthcare

APPLICATION FORM
School of Humanities Study Abroad Program 2015-2016
INFORMATION FOR APPLICANTS
This application form is for School of Humanities students of the Ateneo de
Manila University. Please print this out on A4 paper; feel free to add
additional sheets if necessary. Please answer all questions and submit this
with all other requirements (see “SOH JTA Program 2015-2016 Required
Documents”) on or before the deadline; incomplete applications will not be
processed.
Please attach a passportsize photo (45 mm x 35
mm) here.
APPLICATION DEADLINES:
For Summer Term Abroad 2015: Saturday, 14 February 2015
For Junior Term Abroad 2016: Wednesday, 18 February 2015
INFORMATION – You may fill in the form fields using Microsoft Word, or you may handwrite the information using print
letters.
ADMU ID number:
Surname (as it appears on your passport):
Given name/s (as it appears on your passport):
Middle name:
Year and course (I.S. majors: include
concentrations):
Second major, if any:
Minor programs, if any:
Address in Manila Number and Street:
Subdivision, Barangay:
Postal Code, City, Province:
Permanent Address - Number and Street:
Subdivision, Barangay:
Postal Code, City, Province:
Date of birth (mm/dd/yyyy):
Telephone number:
Email address (an address
you check frequently)
Are you an OAA scholar?
Gender:
Male
Female
Cellphone number:
Cumulative QPI at the time
of application:
Yes
No
If so, please indicate the amount of your scholarship:
STATEMENT OF PURPOSE – In 350 words or less, please describe why you wish to join the SOH Junior Term
Abroad Program. You may attach a separate sheet if necessary. If you already have preferred destination/s or
university/universities, you may indicate it here, along with an explanation for your preference/s.
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PREFERRED JTA SCHEMES – Kindly indicate the JTA schemes for which you wish to be considered. You may
select more than one; please check all that apply.
Yes, I am
interested.
Junior Term Abroad: Fee-Paying Scheme – Second Semester SY 2015-2016
Under the Fee-Paying Scheme, you pay the full tuition of the destination
university abroad. This is usually the most expensive scheme, but there tend to
be more available slots per institution. Some institutions only offer a Fee-Paying
Scheme.
Junior Term Abroad: Tuition-Waiver/Student Exchange Scheme – Second
Semester SY 2015-2016
Under the Tuition-Waiver Scheme, you do not need to pay the full tuition of the
destination university. Instead, you pay to Ateneo a Foreign Student Counterpart
Fee (also known as the ISEP fee) to cover one semester’s tuition of an exchange
student coming to Ateneo. There are limited slots per institution that offers this
scheme, but Ateneo has dozens of partner institutions that offer this scheme.
Junior Term Abroad: ASEAN University Network Credit Transfer Scheme
– Second Semester SY 2015-2016
Under the ASEAN University Network (AUN) Credit Transfer Scheme,
students are given a partial financial grant by Ateneo to study at one of the top
universities in an ASEAN country. The final decision regarding your acceptance
is made by the partner institution to which you have applied, not by Ateneo.
Application is competitive among students from all over ASEAN competing for
slots at each university. As a result, being accepted into the JTA program does
not guarantee that you will be accepted by the AUN university of your choice.
This is open to students who will be juniors during the study-abroad semester.
Junior Term Abroad: ASEAN International Mobility for Students (AIMS)
Programme
Under the AIMS Programme, students may apply to a program offered by
another university that is also part of the AIMS network, a network that includes
universities from seven countries: the Philippines, Thailand, Malaysia,
Indonesia, Brunei Darussalam, Vietnam, and Japan. Successful applicants have
the opportunity to be considered for a scholarship grant offered by the Philippine
Commission on Higher Education that covers airfare and living expenses.
Application for the scholarship is competitive among students from all over Asia
competing for slots at each university. As a result, being accepted into the JTA
program does not guarantee that you will be accepted by the AIMS university of
your choice, nor does it guarantee that you will be given an AIMS scholarship.
Junior Term Abroad: Temasek Foundation LEaRN Programme – First or
Second Semester SY 2015-2016 [full scholarship]
The Temasek Foundation in Singapore, through its Leadership Enrichment and
Regional Networking (LEaRN) Programme, extends financial grants for
students from across Asia to study at a university in Singapore. Application is
competitive, and students are chosen by the Temasek Foundation based on their
leadership or community service record, as well as their academic achievement.
Apart from their academic study, successful applicants also participate in other
activities in Singapore organized by the Temasek Foundation. The School of
Humanities has a screening process to select its nominees for the programme,
but the final decision rests with the destination universities in Singapore. As a
result, being accepted into the JTA program does not guarantee that you will be
accepted into the Temasek Foundation LEaRN Programme or into the TF
LEaRN university to which you have been nominated. This is open to students
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No, I am not
interested.
who will be juniors during the study-abroad semester.
Junior Term Abroad: Sophia AIMS (SAIMS) Program – Second Semester
SY 2015-2016 [partial scholarship]
Apart from its regular student exchange program, Sophia University in Tokyo,
Japan, has a special interdisciplinary study-abroad scheme under the ASEAN
International Mobility for Students Program. The SAIMS program is open to
students interested in spending a semester taking subjects that are geared toward
the field of human development, specifically the theme, “Human Ecology:
Diversity and Connectivity of Science and Nature.” Apart from taking classes
related to this field, students also have the option to do fieldwork and participate
in volunteer work. Successful candidates under this program are given a partial
scholarship. This program is open to students who will be juniors during the
study-abroad semester.
Summer Abroad Program (Fee-Paying) – Intersession Term SY 2015-2016
Held during the intersession (usually June to July 2015), the Summer Abroad
Program allows Ateneo students to take 1 to 2 creditable subjects abroad (the
equivalent of 6 units) at one of Ateneo’s partner universities that accept studyabroad students during the intersession. This is a fee-paying scheme, but is
cheaper than the regular JTA fee-paying scheme because the student will be
abroad for a shorter time. This scheme is open to students who are at least 18
years old on 1 March 2015, have completed freshman year at the Ateneo at the
time of studying abroad, and who have at least one more full term of study upon
returning from abroad. There are a limited number of partner universities that
offer this scheme.
Casa Bayanihan Alternative JTA Scheme
Under this program, the student does not go abroad for her/his JTA term.
Instead, she/he lives with and attends classes with a community of foreign
students from the University of San Francisco undergoing their Casa Bayanihan
experience in the Philippines. Casa Bayanihan is an immersion program that has
four pillars: accompaniment (accompanying the urban poor who live in select
praxis sites which are visited regularly), academics, community (living in
simple community life with other Casa Bayanihan participants), and spirituality
(prayer and spiritual direction). Partial grants are available for this program.
FINANCIAL CONSIDERATIONS – The SOH JTA Program does not award JTA scholarships to students other than
those indicated above. However, a few destination universities do offer a limited number of scholarships/grants on a
competitive basis. If you wish to be considered for these programs that offer scholarships/grants, please describe your
financial situation below.
EDUCATIONAL BACKGROUND
Name of Institution
Academic Years Attended
Elementary
Education
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Awards/Honors Received
Secondary
Education
Tertiary
Education
CITIZENSHIP
Citizenship:
Other citizenship/s:
(passport to be used):
(for holders of dual/multiple
citizenship):
Mother tongue/1st language:
City and country of
birth:
KNOWLEDGE OF LANGUAGES OTHER THAN YOUR FIRST LANGUAGE
Language:
Basic
Intermediate
College-level
Near-native
Basic
Intermediate
College-level
Near-native
Basic
Intermediate
College-level
Near-native
Basic
Intermediate
College-level
Near-native
Reading:
Writing:
Speaking:
Language:
Reading:
Writing:
Speaking:
Language:
Reading:
Writing:
Speaking:
Language:
Reading:
Writing:
Speaking:
TRAVEL HISTORY
Have you ever traveled to or lived in countries other than the Philippines?
Country
Purpose
Approximate dates of visit
INDEPENDENT LIVING
Do you or have you ever lived independently from your parents/primary guardians for an extended period of time (one
month or more)? If so, kindly describe the context in which you have.
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HEALTH AND SPECIAL NEEDS
Do you have any health condition that could prevent a regular schedule of work and study? Please explain.
Do you have any disabilities or disorders (e.g., physical disabilities, learning disabilities, psychological disorders) or similar
conditions that may require special academic accommodations, assistance, or monitoring? Please explain.
CURRENT IPS
Please fill in the catalog numbers & course titles (abbreviations are fine) of the courses that you are scheduled to take
according to your IPS as it currently stands. For current freshman applying for the summer abroad program, please also also
include your IPS for freshman year in a separate sheet of paper.
Second year, 1st semester
Second year, 2nd semester
Third year, Summer Semester
Third year, 1st semester
Third year, 2nd semester
Fourth year, Summer Semester
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Fourth year, 1st semester
Fourth year, 2nd semester
POTENTIAL MAJOR CHANGES TO YOUR IPS – If you anticipate that you will be making changes to your IPS
because you plan to shift to a different major/concentration, or because you plan to take a minor or specialization, please
explain below.
Your signature constitutes a pledge that the written responses to the questions in this application
are accurate and entirely your own work.
_____________________________
Applicant’s Signature
_____________
Date
I hereby endorse the application of ______________________________ to the School of Humanities Study Abroad
Program 2015-2016.
_________________________________
Name and Signature of the Department Chair
_____________
Date
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