Jordan 2023 Service-Abroad Application

Travel dates are May 19 – July 4, 2023. Due to the nature of the program, space is limited to 16 students. Application review begins immediately and continues until all slots are filled. Alternates may be selected. Participants must have successfully completed HON 3306H prior to travel. Students will be notified via email.

All program fees will be assessed via PeopleSoft with due dates in February, March, and April.

Before completing the registration form, make sure you have read the OGESP Policies page and the UH COVID Travel Guidelines. The University requires all travelers purchase CISI Travel Insurance. You must submit your CISI Participant ID card to ogesp@uh.edu.

UH employees (including student workers) are required to complete an Embargo Form, which will be submitted to OGESP upon program acceptance.

Full Name as it appears on your government issued identification. Full Name as it appears on your government issued identification. * First Last
Enter Middle Names with First, separated by a space: "First Middle"
PeopleSoft ID Number *
UH Email Address *
Your Cell Number Your Cell Number * - ### - ### ####

xxx-xxx-xxxx
Date of Birth Date of Birth * / MM / DD YYYY

Required for air travel.
Do you have a valid passport? *

Do you have a valid passport? Yes No
You have indicated you do not have a passport. U.S. citizens can apply for a passport at the on-campus processing facility in the Office of Learning Abroad. You can make an appointment by calling 713-743-4687 or visiting their office at 105 E. Cullen.

The U.S. State Department is reporting the passport processing time is currently 16 weeks. it is imperative that you apply for a passport immediately in order to receive it in time for the trip.
Gender on Passport *
Passport Number *
Passport Issue Date Passport Issue Date * / MM / DD YYYY
Passport Expiry Date Passport Expiry Date * / MM / DD YYYY
Passport Issuing Country *
Emergency Contact's Name Emergency Contact's Name * First Last
Emergency Contact's Email *
Emergency Contact's Phone Number Emergency Contact's Phone Number * - ### - ### ####

xxx-xxx-xxxx
Dietary Restrictions *

Dietary Restrictions N/A Vegetarian No pork/Halal Other Other
Student Career
Are you currently a student in the Honors College? *

Are you currently a student in the Honors College? Yes No

This question has no bearing on eligibility.
What is your current classification? *
What is your current major? *

If undeclared, type "N/A"
What is your current minor? *

If none, type "N/A"
Current cumulative UH GPA *
Previous Experience and Qualifications

In this section, please be as thorough as possible.
Please list any languages you speak other than English and your proficiency level (Beginner, Intermediate, Fluent). If none, please enter N/A. *

This question has no bearing on eligibilty.
Have you previously traveled out of the country? *

Have you previously traveled out of the country? Yes No

This question has no bearing on eligibility.
If so, where and for how long? *

If no, type "N/A"
Previous volunteer experience *
Previous relevant coursework *

Please list coursework you have done that is relevant to this trip. (e.g. courses in Medicine & Society, foreign language, relevant political or social sciences, Leadership Studies, etc.)
Why are you interested in the Jordan Service Learning Program? *

Please explain in 250 words or less your interest in this program. Why are you a good applicant?
How would you define "empathy"? *
What is your understanding of the term "vulnerable population"? *
Describe the color "grey." *
Please list any other skills you might want listed with this application, including leadership and/or managerial experience. *
I acknowledge that I have read the OGESP travel policies. *

I acknowledge that I have read the OGESP travel policies. Yes
I acknowledge that I have read the UH COVID travel guidelines. *

I acknowledge that I have read the UH COVID travel guidelines. Yes
I am aware that I must purchase CISI travel insurance in order to participate in this program. *

I am aware that I must purchase CISI travel insurance in order to participate in this program. Yes
I understand that I must have completed HON 3306H Health & Human Rights with Dr. Valier or Dr. Myrick to participate in this service learning program. *

I understand that I must have completed HON 3306H Health & Human Rights with Dr. Valier or Dr. Myrick to participate in this service learning program. Yes

If you completed HON 3306H with Dr. Lundstroth, you will need to do additional reading that is specific to the Jordan Program. Please email Dr. Myrick.
By checking this box, I authorize the Honors College to post the program fees to my PeopleSoft account. *

By checking this box, I authorize the Honors College to post the program fees to my PeopleSoft account. Yes
UH Employees must self-identify for international travel.
Are you a UH employee? *

Are you a UH employee? Yes No
Vaccination Requirements

As a State institution, UH cannot require vaccination against Covid-19. However, both the School for International Training and the Jordan Health Aid Society International—our partner organizations—do require all program participants to be fully vaccinated, including with an FDA-approved updated bivalent booster. Participants will need to provide proof of vaccination prior to departure.
I understand the vaccination requirement. *

I understand the vaccination requirement. Yes

Jordan 2023 Service-Abroad Application

Jordan 2023 Service-Abroad Application

Student Career

Previous Experience and Qualifications

UH Employees must self-identify for international travel.

Vaccination Requirements