Note: application will not be processed until the $50.00 (U.S.) application fee is sent to the address below. All application materials can be submitted to the Coordinator of International Student and Off-Campus Programs. Mailing Address: Coordinator of International Students and Off-Campus Programs Dordt University 700 7th St NE Sioux Center, Iowa 51250-1606 Phone: 712.722.6273 Fax: 712.722.6035 Email: Rebecca.Tervo@dordt.edu Personal Information Current classification FR SO JR SR Name: Personal email address: Permanent address: Phone: Date and place of birth: Citizenship: Gender: Major: Minor: Cumulative GPA: Health: Have you had within the last three years any physical, mental, or emotional condition that has interrupted your studies or employment for more than a month or that has required hospitalization or professional care? Yes No If yes, please explain. Application Essay Questions Thinking about the whole program, why would you like to be a Semester in Zambia participant? (200-250 words) What is the relationship between the Semester in Zambia and your vocational and personal goals? Have you had any previous experience in a developing country? If yes, when and where did you go? What did you do there? Transcript: Please send an official transcript and list of the courses you are taking at the present time. You may request a transcript by filling out the green transcript request form in the Registrar’s Office. Recommendations: Have two faculty members and either your pastor or a student services member who know you well write letters of recommendation and have them sent directly to the address at the top of this form. Click here for recommendation forms for faculty and student services members to fill out, or request them from Rebecca Tervo at: Rebecca.Tervo@dordt.edu. Application Fee Information A $50.00 (U.S.) non-refundable application fee must be sent to the address at the top or submitted to the Dordt College business office before this application will be processed. Statement Of Faith: Dordt College (Sioux Center, Iowa) and Northrise University (Ndola, Zambia) acknowledge that the Scriptures are the Word of God. As God’s infallibly and authoritatively inspired revelation, the Bible makes known the way of salvation in Jesus Christ, requires a life of obedience to the Lord, and provides the key to understanding, interpreting, and finding purpose in life. It is expected that students will strive to obey the Lord’s teaching in every area of their lives. Students who do not share this Christian commitment may not be in a position to appreciate the Semester in Zambia’s educational and cultural experiences. Students who come to Northrise University should be fully prepared to abide by Christian standards and the policies of the program as expressed in the student handbook. I have read the above statement, and as a future member of the Northrise University community, I agree to live within the expectations and policies of the program. Yes No
