Jamal Esmail Premji Undergraduate Nursing Global Travel Award Student Application Form

The Jamal Esmail Premji Undergraduate Nursing Global Travel Award was established to encourage undergraduate nursing students to engage in activities that bring a global health perspective into their learning.

Undergraduate Nursing students are eligible to receive up to $1000 to either: (1) participate in an applied learning opportunity with a global focus, (2) complete an ‘out of bounds’ integrated practicum in Northern communities, or (3) present at an academic conference with a global health focus (note: those presenting a paper or poster as first author will be given priority).

Applicants must be registered full-time, be in good academic standing. This award is not to be combined with other award funding for the same purpose.

As there are a limited number of scholarships available, submission of an application does not guarantee that students will receive the scholarship. Applications are open September 1 to August 31 each year and are processed on a rolling basis until funds are depleted.

A. Personal & Academic Information
Name Name * First Last
Student ID Number *
Must be 9 digits. Currently Entered: 0 digits.
Email *
Phone Phone * - ### - ### ####
What is your nursing program of study? *

What is your nursing program of study? 4-Year BSc in Nursing 2nd Entry BSc in Nursing Post-RN Internationally Educated Nurses BScN
What is your current year of study? *
At the time of this application, what is your GPA?
(Note: students must have a minimum of 5.5 GPA for participation in York global programs) *
B. Global Travel Activities
Hosting Institutional Partner/Event Name (e.g. name of placement site or conference event) *
Please describe the global activities you are planning and reason for your application. *
Maximum of 300 words allowed. Currently Entered: 0 words.
Planned Travel Start Date Planned Travel Start Date * / MM / DD YYYY
Planned Travel End Date Planned Travel End Date * / MM / DD YYYY
Travel Location (city/town) *
Travel Location (country) *
C. Available Financial Resources

Please describe your available financial resources relating to participation in this global activity. Indicate amounts in Canadian Dollars.

Note: Global awards are limited and will not cover the full cost of travel and expenses.
Total amount of personal resources available for this global activity (includes savings, parental/family contributions, other awards/bursaries etc.): * $ Dollars . Cents
Are you receiving OSAP?

Are you receiving OSAP? Yes No

All funding awarded by York University will be reported to OSAP and may have an impact on your OSAP entitlement. York University regularly provides updated funding information to the Ministry of Colleges and Universities.
D. Estimated Expenses

Please provide estimated costs in Canadian dollars for each of the items below for the entire duration of your planned global activities. If there is no cost anticipated, enter 0.
Visas * $ Dollars . Cents
Some countries may require additional entry level requirements such as work permits. Please check with the consulate for your destination about requirements and costs.
International Flights * $ Dollars . Cents
Budget should reflect economy fares for a returning trip. Include domestic flights if required to reach remote destinations. Additional airfare expenses for leisure or extended travel should not be included here.
Accommodations * $ Dollars . Cents
Please indicate what type of accommodations largely account for this expense item. *
Ground transportation while in hosting country * $ Dollars . Cents
Include commuting transportation, train, taxi, and domestic flights required for your activities.
Conference Registration/ Fees * $ Dollars . Cents
Travel/ Health Insurance * $ Dollars . Cents
York Students traveling abroad for international programs are required to purchase guard.me® insurance. Visit www.guard.me/yorkinternational for quotations and to purchase appropriate coverage.
Health Related Expenses * $ Dollars . Cents
Costs may include travel clinic costs, vaccinations, prophylactic drugs (prescription & over the counter) related specifically to global travel.
Meals * $ Dollars . Cents
Other Anticipated Expenses not previously addressed: $ Dollars . Cents
Please describe any other expenses budgeted. If there are none, answer N/A.
E. Personal Statement
How will this experience help to further your personal, academic and/or professional goals? *
Maximum of 300 words allowed. Currently Entered: 0 words.
What else would you like us to know that is relevant to your application? (optional)
Maximum of 300 characters allowed. Currently Entered: 0 characters.
D. Acknowledgement and Consent

I hereby certify that the information provided on this application form is accurate, to the best of my knowledge. All information I have provided in connection with this application is subject to verification and audit by York University.
I understand that my application will be cancelled if misrepresentations are discovered and I agree to provide supporting documentation to York University upon request.
This consent expires one year after the date of my signature.*
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Jamal Esmail Premji Undergraduate Nursing Global Travel Award Student Application Form

Jamal Esmail Premji Undergraduate Nursing Global Travel Award Student Application Form

A. Personal & Academic Information

B. Global Travel Activities

C. Available Financial Resources

D. Estimated Expenses

E. Personal Statement

D. Acknowledgement and Consent