Application for 2013Study of the U.S. Institute on U.S. Secondary Educators

Application for 2013Study of the U.S. Institute on U.S. Secondary Educators

Application for 2013Study of the U.S. Institute on U.S. Secondary Educators

Due to by: Saturday, December 15, 2012

Study of the United States Institutes for Secondary Educators are intensive post-graduate level academic programs with integrated study tours whose purpose is to provide secondary school educators and school administrators with the opportunity to deepen their understanding of U.S. society, culture, and institutions. The ultimate goal is to strengthen curricula and to improve the quality of teaching about the United States in academic institutions abroad. The institute has been offered on the following topics. Please mark which program you are applying for:

  1. ______The Institute for Secondary School Educators
  2. ______The Institute for School Administrators

Note: Average one scholar/per program session will be nominated. For more information on each of the program please refer to the fact sheet.

A. Nominee’s Full Name, as it would appear on his/her passport.

First Name(s)

Middle Name(s)


B. Gender

C. Date of Birth (please spell out Month, Day, Year):

D. City of Birth

E. Country of Birth

F. Citizenship

G. Residency

H. Medical, Physical, Dietary or other Personal Considerations: Please state if the candidate has any existing medical conditions or is currently taking any prescription medication. This will not affect candidate selection, but will enable the host institution to make any necessary accommodations.

I. Candidate Contact Information




J. Academic Major

K. Work and Volunteer Experience

L. Year in School (Highest degree earned):

M. Memberships in Associations, Clubs, etc.

N. Previous Experience in the United States: Please list any and all trips the candidate has made to the United States and include approximate dates and the reason for travel.

O. Family Residing in the United States: Please list any immediate family members who are currently residing in the United States, including city and state.

P. Evidence of English Fluency

Q. Justification statement by nominating officer (what encouraged you to nominate this individual?) (to be completed by nominating officer). Please fill out all information on the application form properly, except for section Q, which should be completed by the US Embassy.

R. Personal Statement (no more than one page – to be completed by applicant)

For the candidate: Please be as specific as possible.Tell us about yourself and your goals including the following: What about your background and/or interests that makes you competitive for this particular institute? What will you contribute to the group? How do you expect this experience will affect your future academic and professional career? How will it affect you personally? Please structure your essay in paragraphs and limit your response to 250 words.