Personal Information
First Name (as it appears on your ID)
Last Name
(as it appears on your ID)
Lived First Name
Pronouns
UC Berkeley Email
Non Berkeley Email
Phone
SID
Birthday
Hometown
Language: If you speak any other languages, list them and describe your proficiency (can read/write/speak)
Racial or Ethnic Identity
Racial or Ethnic Identity
Please select...
American Indian/Alaskan Native
Bi-Ethnic or Multi-ethnic
African/African-American
Asian/Asian-American
Chican@/Latin@
White
Pacific Islander
I do not identify with the above options
Decline to State
If you selected “I do not identify with the above options”, or would like to provide details about your race/ethnicity, please do so in the field below.
Gender Identity
Gender (select all that apply):
Woman
Man
Nonbinary
Transgender
Other
Decline to State
If you selected Other or would like to provide more details about your gender identity, please do so in the field below.
Educational Information
Graduation Year
What is your degree program?
What other time commitments will you have next year?
Short Answer Questions
Please limit your answers to 325 words for each question.
1.
Why are you interested in the Chan Fellowship GSF role? How do your prior experiences prepare you for this role, and what do you hope to learn/develop from this experience?
2.
The Public Service Center aims to live and practice our values. Please identify one of our values & share how it resonates with you.
3.
How will you support international students as they adjust to US culture, host families, and internship sites?
4. Please share a time when you formed a relationship with an individual or individuals who had a different identity, life experience, and/or value than your own. What helped you build a relationship with this individual or group of individuals, even though there were differences?
References
Please provide contact information for two references, people who can speak to your leadership potential, commitment to serving the public good. References should not be peers or family members.
Reference #1
Name
Title/Org
Phone
Email Address
Reference #2
Name
Title/Org
Phone
Email Address
Additional Information
How did you hear about this program?
Would you like to receive a monthly email of service and leadership opportunities, scholarships, and more?
Yes
Resume Upload
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