Global Learning Application Form Fill out the form carefully and send it with the required attachments. University you apply to*Please selectUniversité libre de BruxellesPrince of Songkla UniversityKU LeuvenUdayana UniversityPannasastra UniversityType of program you apply to*Please selectShort Summer/Winter ProgramSemester ProgramStudy semester(s) you apply to*Please selectAutumnSpringAutumn & SpringSpring & AutumnStudy abroad year(s) you apply to (e.g. 2019 or 2019-2020)*English language proficiency *Please selectNative SpeakerNear Native/FluentExcellent CommandVery Good CommandGood CommandBasic Communication SkillsPERSONAL INFORMATIONFull Name*Please selectMrMrsMsMissDrPrefixFirstMiddleLastDate of Birth*Gender*Please selectMaleFemaleEmail address*Phone Number*Address*Nationality*Please selectAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'IvoireCroatia (Local Name: Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts And NevisSaint LuciaSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia, South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre And MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabwePassport Number*CURRENT HOME INSTITUTION (if applicable)Institution name*Please use the official English name if availableDepartment/faculty you are studying inContact (eg. study abroad advisor) Your contact person at your home university for studying abroad.University contact person's emailYour study year PREVIOUS EDUCATIONAL BACKGROUNDSchool, degree/major subject*WORK EXPERIENCEEmployer, position/job description (if applicable)CONTACT PERSON AT HOMEFull name of contact person*FirstLastContact's phone*Contact's e-mail*Relationship to you*(e.g. mother or father)INFORMATION FOR GLOBAL LEADERSWhere did you hear about Global Learning and the study program you are applying for?From a university lecturer or a study abroad advisorEmail from student organizationFriend or another fellow student told me about itUniversity's websiteSearch engine (e.g. Google)FacebookOther social mediaPrinted advertisement We would very much appreciate if you could be more specific how you found out about Global Learning and the study program you are interested in.Please tell us how will this Study Abroad Program shape you as a leader?Please tell us why you have chosen this study destination?REQUIRED ATTACHMENTS Instructions for the attachments Please upload the below mentioned documents to your application as attachments. The documents could be scanned and saved to the applicant's computer or you can also take a digital picture of the required document. Try to keep the file sizes of your attachments minimal, whenever possible (max. few megabytes per attachment), and preferably send them in PDF format. If you are unable to send the attachments at the same time as the application, you can send the required attachments to us later by emailing them to info@studyabroadalliance.com 1) Transcript of records from your university in English (max. 1 MB)2) Copy of the first page (identification page) of your passport (max. 1 MB)3) A color photo (max. 1 MB)4) Any additional attachment (max. 2 MB)Are you human?*SendThis field should be left blank