Faculty of Education and Arts Short Term International Study Experience (STISE) Application Form ACU is committed to ensuring the privacy of all information it collects. Personal information supplied to the University will only be used for administrative and educational purposes of the institution. Personal information collected by the University will only be disclosed to third parties with the written consent of the person concerned, unless otherwise stated by law. For further information please see the University’s Statement on Privacy located at http://www.acu.edu.au/145293, and the Student Administration Privacy Policy located at http://students.acu.edu.au/343746. CRICOS 00004G 1. CHECKLIST STISE Unit Title and Code Application Due Date: Please provide the following supporting documentation with your application: Copy of current transcript (you can find your transcript in Student Connect) Completed student questionnaire (attached to the end of this form) Once complete, please return this form and supporting documents to: E-mail: 2. PERSONAL DETAILS ACU Student Number Family Name Title Mr Ms Other First Name/s Preferred Name Previous Family Name (if applicable ) Date of Birth day month year Sex Male Female Contact address for correspondence (you must notify us immediately if this changes) Permanent address (if different from Contact Address) PO Box or Street Address PO Box or Street Address Suburb Suburb State State Postcode Postcode Telephone Number/s E-mail address/es Please note that official university correspondence will always be sent to your ACU student e-mail account. 1) 2) Are you a citizen of Australia? Yes No Æ If no, please indicate your country of citizenship. _______________________________________________ Do you have dual citizenship with any country? YesÆPlease indicate which country__________________________________________________________________________ No Kiribati Learning Experience 5pm, Friday 5 May [email protected] S00185150 Feraset Rona 05 10 1996 60 Duckmallois ave Blacktown 2148 NSW 0421453964 96752200 [email protected] [email protected] 3. EMERGENCY CONTACT INFORMATION - NEXT OF KIN (NoK) Name Telephone Number Mobile Number E-mail address Relationship to You If my application is successful and I participate in this international study experience, I authorise ACU to contact my nominated NoK in the event of an emergency, illness/health issues or an accident sustained during my participation.. Yes No If you ticked “yes”, then ACU will decide when it is necessary to contact your NoK. 4. CURRENT STUDIES AT AUSTRALIAN CATHOLIC UNIVERSITY Your current ACU Degree and Major(s) Current year of study (year 1, 2, 3 etc.) ACU Campus Ballarat Brisbane Canberra Melbourne North Sydney Strathfield Are you an International (i.e. non-domestic) Student? Yes No 5. SAFETY AND WELLBEING Do you have an ongoing physical or medical health condition that may affect your participation in the international study experience? (This includes any illness, or physical or psychiatric condition, including any notifiable disease, that may impact adversely on your capacity to pursue and benefit from the international study experience or that creates a risk to the successful delivery of that experience.) A successful international study experience will depend largely on making preparations and planning ahead so that your health-related support needs can be met whilst you are abroad. IMPORTANT: All students accepted on to the international study experience must be evaluated for their fitness to travel by their medical practitioner prior to departure. All information provided is confidential. The information that you provide will assist ACU to ensure you have access to the most appropriate resources during your internship. Please note: failure to disclose health conditions and special needs is a form of student misconduct and may result in the delay or termination of your participation in the international study experience. Yes Æ if yes, please specify below No mental health hearing vision mobility learning medical allergies or dietary concerns, please specify::________________ _______________________ _______________________ other, please specify:_________________ _______________________ _______________________ _______________________ _______________________ Are you registered with the Equity and Disability Unit? Yes No 6. STUDENT DECLARATION • I declare that, to the best of my knowledge, all information on this form is complete and accurate. • I understand that Australian Catholic University (ACU) may, with due regard to ACU’s Privacy Policy, exchange information with provider organisations to administer the international study experience and may provide information to Government bodies as required by law. • I understand that ACU reserves the right to vary any decision made on the basis of incorrect or incomplete information supplied by me in this form. • I accept that the submission of this form does not guarantee me a position on the international study experience and that there is a selection process involved. Applicant Signature Date ______/______/201 Gunsen Feraset 0403252965 96752200 [email protected] mum Bachelor of Education (Primary) year 3 11 05 73 STUDENT QUESTIONAIRE (please complete and return with your application form) 1. Have you been on an international study experience with ACU previously? ☐ No ☐ Yes If yes, please provide details: 2. Why do you think that you should be considered for the international study experience? 3. Why do you want to participate in the international study experience? 4. What are your expectations of the international study experience? 5. What do you want to achieve by undertaking the international study experience? 6. How do you respond and cope with stressful or crisis situations? 7. How do you respond and/or manage with conflict situations? 8. If you are selected for the international study experience, how will you be a positive ambassador for ACU? 9. Outline your understanding of community engagement (if applicable): 10. Please outline any previous international or domestic travel experience: I believe I should be considered for the international study experience because, I will be a great asset for the students overseas. I am very passionate about teaching and have always wanted to help those less fortunate then me. I want to participate in the international study experience because it will be an unforgettable experience, as I will be able to experience a different education system, it will give me a better perspective, which will influence my future career. I will be challenged to approach issues from different perspectives, I think this experience will benefit my learning significantly. My expectations of the international study experience is that i will be given the opportunity to improve on my teaching pedagogy, opportunity of living in a different country, different perspective on how children are taught in other countries. By undertaking this experience I hope to achieve a better understanding of students living overseas, I hope to gain better knowledge, and most of all I hope I can make a difference with the lives of the children at the school and in the future to do more to help students who don’t have the same education benefits as we do in Australia. When it comes to stressful or crisis situations, I respond very well and I am very calm, I have had many experience with stressful and crisis situations, throughout my life time and the way I deal with them is one of my great qualities. Through schooling and work I have had many experiences with conflict situations, I believe the best way to respond or manage conflict is to avoid it but if it cannot be avoided then the best way to manage or respond is by having a positive and calm mind set, talking though the issue and listening to what the other person has to say and being understanding. If i were to be selected for the international study experience, I will be a positive ambassador for ACU by embracing ACU mission statements by being very respectful for social,cultural, religious, and ethnic backgrounds of all people and putting, being good role model, being a good team player, willingness to work, have great listening and communication skills. Community engagement means enhancing the dignity and wellbeing of people and communities, especially those most marginalised or disadvantaged. I have traveled to quite a lot of places, the places I have visited are Turkey, Greece, Italy, China, Singapore, Dubai, Thailand, Pacific Islands such as Vanuatu, Isle of Pines, Noume, New Zealand, Tasmania.