Part 1: Personal Information

Fields marked with an asterisk (*) are required. If you experience any issues completing this form, email us at CPMCscholarship@buffalo.edu.

Street address
Apartment, suite, unit, building, floor, etc.
Status*
Class Year*

Part 2: Study Abroad/Experiential Learning Program Information

Program Brochure*
No File Chosen
File uploads may not work on some mobile devices.
Please attach program brochure.
City, Country
Have you applied for this program?*

Please indicate your anticipated term.

Semester*
ex: 2019

Please describe the budget for this experiential learning experience. Mark "N/A" for items included in the program fee.

Please indicate the items included in the program fee.

Check all that apply.

Indicate other scholarship awards that you’ve secured and/or applied for to offset your study abroad or experiential learning expenses.

Scholarship status
Scholarship status

Part 3: Essay Questions

Essay Questions

Please answer the following three questions on a separate sheet.

  1. Describe your academic and career goals and how experiential learning will help you achieve them. Please explain why you have selected your experiential learning experience. Briefly describe any previous experiential learning experience(s).
  2. How do you plan on promoting experiential learning upon your return? List specific examples.
  3. If studying abroad is part of your experiential learning experience, what one aspect (i.e. cultural, historical, political, event or person) of your host country has most contributed to your desire to study there? Please explain.


Essay instructions: 

  • All three of your essay answers must be on the same document. Please number your responses.
  • Answers must be typed, single spaced, using 12-pt. font.
  • Suggested length is 250-500 words for each question.
Upload your essay answers document:*
No File Chosen
File uploads may not work on some mobile devices.

Part 4: Other Documents

Please upload your resume.*
No File Chosen
File uploads may not work on some mobile devices.
Please upload your CPMC Related Experience document.*
No File Chosen
File uploads may not work on some mobile devices.

Part 5: Application Certification

Please note the following items:

  • Applicants will be informed via email concerning the disposition of their application upon completion of the review process.
  • This is a one-time award.
  • Students are expected to stay within their approved budget, as additional funding will not be made available.
I certify that the information given is correct. If I am a recipient of the CPMC Experiential Learning Award, I hereby give permission for my name and the name of my program to be released as a recipient of this award. I also give permission for my contact information to be released to other students interested in experiential learning.*
I consent to Buffalo.edu collecting and storing my data from this form.*
Save and Resume Later
Progress
Cancel
Confirm