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Associate Information:
First Name: Last Name:
Address 1: Address 2:
City: Postal code:
State/Province:  
Country:
If your country is not listed, please add it to the comments at the bottom of this form.
Phone: Cell:
Email: Website:
Gender: male female Birthdate: (YYYY)
Language:
What is your native Language?
Competency in English:
Written: Spoken: Understanding:
Program selection You need to make a selection from all three fields before options are displayed!:
Choose a start date from the available options:
(Make sure you select a date, if available, even if it is only one!)
September 26th - October 9th, 2006
September 18th - October 2nd, 2007
International Advisory Board Meeting Please check the one(s) you want to attend::
August 25th - 27th, 2006 in Germany:
October 6th - 8th, 2006 in the USA:
Tell us what is going well in your life, personally and as a world changer:
Please max. 200-250 words, currently
Also let us know what is difficult in your life, personally and as a world changer:
Please max. 200-250 words, currently
What are your long term goals and visions?
Please max. 400-500 words, currently
What are your next achievable steps?
Please max. 200-250 words, currently
Please tell us about your plan for funding your Gaia University fees.
For MSc and Diploma in Integrative EcoSocial Design only:
Have you completed a certified Permaculture Design Course? Yes No
When have you done this?
Where have you fulfilled this requirement?
Who were the principal instructors/teachers?
Have you completed a certified Ecovillage Design Course? Yes No
Have you completed any equivalent design study? Yes No
Tell us about the details and your role in any project in the field of designing sustainability/regeneration:
Please max. 200-250 words, currently
Describe the Masters (or Diploma) level strategic qualities of your degree project?
Please max. 200-250 words, currently
What are your major areas of interest?
Please max. 200-250 words, currently
International Bursary Fund for students with lower resources:
Through a generous donation to the International Bursary Fund we have a limited number of partial scholarships available. We are reserving these for the most promising candidates who are also in need of economic assistance. Please check this box if you will be applying for this financial aid.
Would you be interested to make a donation to this fund: Yes No
How much would you be able/willing to contribute:
Please check if you are making this donation now through our Pay Pal system:
Please list two people who know your work and their contact email addresses and websites where applicable:
Please include a Curriculum Vitae of your prior education and life/work experience:
Please max. 500-1000 words, currently
Please add any further comments to be taken into account in considering your application:
 
 
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