Himalaya Semester Passage – Application Form

Note: Minimum of 5 participants needed for this program to run.

If you would like to participate in our Himalaya Semester Passage program, please fill out the application form.

The signed waiver must be sent to:

VIDHEA SHRESTHA
Programs Director
Passage International
GPO Box 8974
CPC 373
Kathmandu, Nepal

Once an applicant has been approved, we will send out health forms, equipment lists, air travel instructions and further information about the trip.

Checklist: Your application will not be considered complete without the following

Application
Health Form
Waiver

Deposit of $500 by wire transfer to:

Account Number	5897900
Account Name	Passage International
Bank Name	Nepal Investment Bank Ltd.
Swift Code	NIBLNPKT
Bank Address	Durbar Marg, Kathmandu, Nepal

Himalaya Semester Passage Spring/Fall, Year:

Please fill in all the fields.

Your Personal Information
Name:
Age:
Nationality:
Passport #:
State where issued:
Date of issue:	(day/month/year)
Date of expiration:	(day/month/year)
Your email address:
Your current address:
Phone:
Parents' names:
Parents' email:
Parents' address:
Parents' phone:
Emergency contact number:
Please give us the name(s) and age(s) of your sibling(s):

Please give us the name of a reference for you at your school (such as your guidance counselor):
School's name:
School's contact:
Relationship to student:
Contact's email/telephone:
School address:

Please tell us briefly about yourself, your education, your interests and your family.

Why do you want to participate in a Passage program and what do you plan to do when it is over?

Have you ever traveled abroad? If so, where and what were your experiences?

Do you have any experience in the outdoors?

What is your greatest concern about participation in Passage International?

What aspect of the program most/least interests you? most = ***** least = *
Cross-cultural experience (home stay)
Language learning
Individual exploration
Independent study projects
Outdoor experience (trek)


Independent Study Projects - Options
The Arts Sitar, Sarod, Drums (tabla/dhime/madal), Tibetan Guitar (Dunyen), Tibetan dulcimer (Gyanchen) Folk, Indian classical, Carya, Tibetan dance Painting (thangkas) Wood-carving Mask making Prayer Flag making Weaving (carpets/backstrap looms)/Bamboo weaving Jewelry making Bronze casting Stone carving Hand printing textiles Pottery Tibetan/Nepali cooking Esoteric Studies Yoga Buddhist meditation Medicine Tibetan medicine Ayurvedic medicine Development & Service (Minimum of 12 weeks participation) Organic farming Teach English Women's craft cooperative Social service Art history and architecture Ecology and Preservation

Do you have any preferences to the type of family you would like to live with? Take into consideration your needs for privacy and modern comforts.

How did you hear about Passage International?

If you found out about our programs from our website, where did you link to us from?

What other programs, if any, were you considering?

I am enclosing my application fee of $500 (made payable to "Passage International").
Full Name:	Date:

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