Application

Recommendations

Student Personal Information

First Name

Last Name

Phone Number

- -

Address

City

State

Zip Code

Allergies

We will be providing snacks and lunch during the program. Please list any food allergies.

T-Shirt Size

Other T-Shirt Size

If you need a size not available in the field above, enter the t-shirt size here.

Language Background

Student's Native Language

Other Native Language

If student's native language is not available in the field above, enter other language here.

Previous Kiswahili Training

Yes

Describe Kiswahili Training

Please explain your Kiswahili language ability in reading, speaking, writing, and listening.150 words left

Student's School Information

Name of School

Other School

If student's school is not available in the field above, enter other school name here.

Grade

Parent/Guardian Information

Parent/Guardian Name #1

Parent/Guardian Name #2

Parent/Guardian Phone

- -

Parent/Guardian Email

Parent/Guardian Address same as Student Address

Parent/Guardian Address

Parent/Guardian City

Parent/Guardian State

Parent/Guardian Zip Code

Emergency Contact Information

Emergency Contact Information same as Parent/Guardian Information

Emergency Name

Emergency Email

Emergency Phone

- -

Emergency Address

Emergency City

Emergency State

Emergency Zip Code

Relation to Student

Personal Statement *

Personal Statement

Why are you interested in joining the KU Kiswahili STARTALK Academy? What do you desire to gain by participating in the program? What makes you a good fit for the KU Kiswahili STARTALK Academy, given STARTALK’s mission?

500 words left

Teacher Recommendation Information

Supply contact information of a teacher who can provide a recommendation for you. All recommendation forms should be submitted no later than 5PM, April 20, 2019.

Recommending Teacher's Name

Recommending Teacher's Email

Recommending Teacher's Phone

- -