APPLICATION FORM FOR PEACE BY PEACE SHORT

COURSE 2018

Full Name: _______________________________________

Country of Origin:__________________________________

Date of Birth: _____________________________________

E-mail: __________________________________________

INSERT PHOTO HERE

I hereby apply to the UWC Short Course “Peace by Peace” that will take place June 25th to
July 5th of 2018 in Phuket, Thailand.

I certify that the information I have provided in my application is complete, true and correct,
and that Sections A and B were answered by myself.

In case of admission to the UWC Short Course I will participate in all steps of the program,
contributing to the interaction and learning with curiosity and motivation. My parents/legal
guardians have been informed about my application and have agreed to it.

I am aware that English will be the language of communication and instruction during the Short
Course. I am confident that my knowledge of English is sufficient for these purposes.

Place and date: ____________________________________

Signature: _____________________________________

Note: To fill in this application form digitally, open the PDF file in Adobe Acrobat Reader
(download available here) , fill in all the fields and make sure you save the file after you’re
done as it won’t be saved automatically. You can fill in all the signature fields by simply
typing in the names. You can add your photo by clicking on the photo field and selecting a
file.
 General Information
UWC makes education a force to unite peoples, nations, and cultures for
peace and a sustainable future
UWC Mission Statement

Peace by Peace

UWC Short Course 2018 in Phuket, Thailand

For more information about Peace by Peace, access:

http://www.uwcthailand.net/learning/uwct-short-course/

Please join us on Facebook for more updates!

https://www.facebook.com/UnitedWorldCollegeThailand/

For more information regarding UWC Short Courses, access:

http://www.uwc.org/shortcourses

Participation costs: Costs of participation are usually covered by the participants and will
amount to 1400 USD (excluding travel expenses, visa fees, and pocket money). However,
as in the case of application to a United World College, financial constraints should not be a
reason to forgo the chance of an application. If necessary, PxP can provide successful
applicants with partial or full scholarships. Financial aid forms can be found on the website if
you wish to pursue this.

Once you have filled in this application form, please send it to

peacebypeace@uwcthailand.ac.th
 Section A
To be completed by the applicant

(Please type or write clearly in dark ink and ensure you complete all the sections that are
applicable to you)

Personal Information
As shown on passport or other identification documents
Family name/ Surname/ Last name: _______________________________________
First name/ Given name(s): _________________________________________________
Middle Name (only if noted on passport): ______________________________________
Gender: Male Female Other
Date of Birth (dd/mm/yyyy): ____________________________________________
Nationality(ies): ____________________________________________
Country(ies) of birth: __________________________________________________
Country of Citizenship (on which passport will you travel): __________________________
Home Phone (including country code): ______________________________________
Cell Phone (including country code): ______________________________________

Permanent Home Address:

Address Line 1: _______________________________________________________
Address Line 2: _______________________________________________________
City: _______________________________________________________
Province/Territory/Region: _________________________________________________
Post Code: _______________________________________________________
Country: _______________________________________________________

Courier Address (to receive post, if different from home address)

Address Line 1: _______________________________________________________
Address Line 2: _______________________________________________________
City: _______________________________________________________
Province/Territory/Region: _________________________________________________
Post Code: _______________________________________________________
Country: _______________________________________________________
Phone: _______________________________________________________
 Section A
School Information

Which year of school are you currently in? ______________________________________

English proficiency: (Please tick the box that best applies to you. We need to be aware of this
as English is the language of communication and instruction.)
Beginner
Elementary
Intermediate
Advanced
Proficient

Name of School: ________________________________________________________

Address of School: ________________________________________________________
________________________________________________________
________________________________________________________

Telephone number of school: ____________________________________________

Email Address of School: ____________________________________________
Name of Head of School: ____________________________________________

I hereby agree that UWC Thailand may transfer some relevant aspects of my personal
data, such as name, address, email and telephone number, to other participants of the
UWC Short Course.

Place and Date: _________________________

Signature: ____________________________________
 Section B
To be completed by the applicant.
To ensure that we understand the merit of your application, please take some time to think
about these questions and answer them clearly.

1. Please describe what motivates you and how you see yourself affecting change in your
community and in the world. Feel free to share a personal story. (150 word limit)

2. Describe your personal strengths and weaknesses. Try to include both areas in which
you can teach and areas in which you would like to learn from others. (100 word limit)
 Section B
3. Explain why you are interested in attending the UWC Short Course “Peace by
Peace.” (150 word limit)

4. Finally, convince us to select you. What can you contribute to the Short Course? And
how will it affect your life? (150 word limit)
 Section C
To be completed by the person(s) who has legal duty of care for the student.

Person 1
Relationship to Student: __________________________________________________
Family Name/Surname/Last Name: ____________________________________________
First Name/ given name (s): __________________________________________________
E-mail: _____________________________________________________________

Permanent Home Address (if different from student’s)

Address Line 1: _______________________________________________________
Address Line 2: _______________________________________________________
City: _______________________________________________________
Province/Territory/Region: _________________________________________________
Post Code: _______________________________________________________
Country: _______________________________________________________
Home Phone: _______________________________________________________

Person 2 (if applicable)

Relationship to Student: __________________________________________________
Family Name/Surname/Last Name: ____________________________________________
First Name/ given name (s): __________________________________________________
E-mail: _____________________________________________________________

Permanent Home Address (if different from student’s or Person 1’s)

Address Line 1: _______________________________________________________
Address Line 2: _______________________________________________________
City: _______________________________________________________
Province/Territory/Region: _________________________________________________
Post Code: _______________________________________________________
Country: _______________________________________________________
Home Phone: _______________________________________________________
 Section C
To be completed by the person(s) who has legal duty of care for the student:

Please give a brief description of any medical or mental health concerns, physical
impairments, serious illness or allergies that the applicant may have:

Please list any special dietary requirements that the applicant may have for medical, religious,
or ethical reasons:

I have read and understood the information section at the beginning of this application
form and the application to a UWC Short Course made by my son/daughter/ward; we
have discussed all aspects of the commitment involved and this application has my full
approval.

Should the application be successful, I hereby undertake for myself and for my
son/daughter/ward to observe the rules, regulations and guidelines of the program. I
recognize that the organizing committee has the right to exclude my son/daughter/ward
for violations of such rules, regulations and guidelines. While my son/daughter/ward is
at the UWC Short Course, I authorize the organizational team to act ‘in loco parentis’ in
decisions directly affecting their health and welfare when it is neither possible nor
practical to contact me beforehand.

Place and date: ___________________________

Signature(s) of the
person(s) who has
legal duty of care
over the applicant: _____________________________________________

_____________________________________________