Center for the Study of Global Change

A unit of the Office of the Vice President for International Affairs (OVPIA)

International Studies Summer Institute 2010
APPLICATION FORM

Today's Date: February 14, 2012

To apply for ISSI 2010, please complete the following on-line application AND click on the "Submit" button at the bottom of the page. Mandatory fields are noted with an asterisk (*). NOTE: If you have any problems using this on-line application, please contact us at issi@indiana.edu or 812-856-1768. Thank you.
TEACHER INFORMATION:
	First Name:*
	Last Name/Surname:*
	Home Street Address:* (NOTE: P.O. Boxes NOT accepted)
	Home City:*
	Home State:* Describe "Other": (if applicable)
	Home Zip (Postal Code):*
	Home Country:*
	*Home Phone: (NOTE: Include country code for non-U.S. numbers)**
	Home E-mail Address:* (NOTE: You will be receiving important communications by email)
	Passport Number: (NOTE: Mandatory if not a U.S. citizen)
	Country where passport was issued: (NOTE: Mandatory if not a U.S. Citizen)
	Date of Birth:*
	Gender:*
	Were you nominated to ISSI by one of the following: (Check the following list and highlight one.) Enter specific area studies center (if applicable):
	Primary (and other) languages spoken at home:*
	Travel Abroad: (if any)
SCHOOL INFORMATION:
	Name of School:*
	School Street Address:*
	School City:*
	School State:* Describe "Other": (if applicable)
	School Zip (Postal Code):*
	School Country:*
	*School Phone: (NOTE: Include country code for non-U.S. numbers)**
	School Fax: (optional) (NOTE: Include country code for non-U.S. numbers)
	School E-mail Address: (optional)
	What grade(s) do you teach?* (select one or more) 6th 7th 8th 9th 10th 11th 12th College Undergraduate Level College Graduate Level Other
	What subject(s) do you teach?*
PERSONAL INFORMATION:
	Please check the world areas about which you are most interested in learning more.
	Africa
	Latin America
	East Asia
	Middle East
	Eastern Europe
	South/Southeast Asia
	Inner Asia
	Western Europe
	Please list your specific countries of interest.
	Please state the international issues that interest you the most.*
	Where did you hear about this institute?*
	*Please write a brief statement describing the benefits to you and to ISSI from your participation at the institute. (NOTE: Your application will NOT be accepted unless you COMPLETE this statement.)**
APPLICATION PROCESS:
	In order to have a COMPLETE ISSI application package, we must receive from you ALL of the following: AN APPLICATION Submit this application on-line over the Web by CLICKING ON SUBMIT BUTTON BELOW. If you are having technical problems submitting this application online, please contact us at 812-856-1768 or issi@indiana.edu. A RÉSUMÉ E-mail (issi@indiana.edu), fax (812-855-6271) or mail us your résumé (to the address below). A LETTER OF RECOMMENDATION Have your department head, principal, or a colleague email (issi@indiana.edu), fax (812-855-6271), or mail (to the address below) a signed letter of recommendation. International Studies Summer Institute 2010 Center for the Study of Global Change Indiana University 201 N. Indiana Avenue Bloomington, IN 47408-4001
	As soon as we receive your COMPLETE ISSI application package, your information will be reviewed and you will be contacted by email regarding your acceptance status.
	Please remember to click on the "Submit" button below to complete this on-line application. Thank you.

Indiana University is an equal opportunity/affirmative action institution. If you have a disability and need assistance, special arrangements can be made to accommodate most needs.

Center for the Study of Global Change
201 N. Indiana Ave., Bloomington, IN 47408-4001
Phone: (812) 856-5523 Fax: (812) 855-6271 E-mail: global@indiana.edu
This page page was last modified on: 11/8/11