Please fill out the below information. Items marked with "*" must be completed.
If you have any questions, please contact Eva Li at eva.li@asiainstitute.org.

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Contact and Background Information

Student Applicant Name:  *
Student ID Number:  *
Student Applicant Nationality:  *
* If you hold dual-citizenship, please provide both countries of which you are a citizen.
Student Applicant Degree/Major:  *
University Name:  *
Student Email:  *
Student Phone Number:  *

Global Learning Experience Details

Global Learning Program Title:  *
Global Learning Program Host:  *
Global Learning Program Country:  *
Global Learning Program Dates:  *
* The global learning experience must have a start date between January 1, 2018 and December 31, 2018.

Program Cost

Tuition and Fees:  *
Program Cost:  *
Round-Trip Airfare:  *
Total Cost of Study Abroad Program:  *

How will you pay for your study abroad program if you do not receive the PaCIE - Asia Institute joint scholarships?

Parent Contribution/Self Contribution:  *
Other Scholarships/Grants/Loans (Government/Private):  *
Total Projected Financial Resources for Study Abroad:  *
* Please note, your Total Projected Financial Resources for Study Abroad must equal to your Cost of Education Overseas.
Global Learning Experience Overview (200 words or less)  *
What Do You Hope to Achieve? (500 words or less)  *
Why Are You Deserving of the Scholarship? (300 words or less)  *