2016 Benjamin Franklin Transatlantic Fellows

2016 Benjamin Franklin Transatlantic Fellows

Summer Institute for Youth

♦ APPLICATION ♦

A. Last (family) name as on passport:

B. First name as on passport:

C. Middle name(s) as on passport:

D. Date of birth (month/day/year – please spell out the month):

E. City of birth:

F. Country of birth:

G. Country of residence:

H. Country of citizenship:

I. Gender:

J. Position (Choose from "Secondary School Student","University Undergraduate Student", or "Special School,Institute, or Vocational Student".):

K. Nominee’s full address:

L. Home telephone number and mobile phone number:

M. E-mail address(es):

N. Medical, physical, dietary, or other personal considerations (Please describe any pre-existing medical conditions, including any prescription medication the candidate maybe taking, or any other dietary or personal considerations. This will not affect candidate selection, but will enable the host institution to make any necessary accommodations.):

O. Name of nominee’s high school or college/university:

P. Nominee’s field of study (if applicable):

Q. Any other relevant educational, academic and professional experience or training:

R. Active memberships, special interests, or extracurricular activities (please list your achievements, competition results, volunteering):

S. Previous travel or study experience in the United States.Please include dates and purpose:

T. Evidence of competence in written and oral English (e.g. school grades):

U. Future study or career plans:

V. Essay #1 (in no more than 700 words please answer below):

Why are you an ideal candidate for this program?

W. Essay #2 (in no more than 700 words):

If you could go back in time, where would you go and why?

To apply: Completed application(together with two essays - 700 words maximum each),two recommendation letters (teachers, trainers, coaches …), academic records from the last year should be sent to the U.S. Embassy by March 4, 2016. Incomplete applications will not be accepted. Please do not send copies of awards, diplomas etc. (please list all your achievements under R. in this application).

Please send complete documentation to the email only:

You should receive an automatic email reply when you send your application, confirming that your application was received. If you don’t receive it within 24 hours, your email was not received and you should contact us by phone immediately.

For all questions, please contact Ms. Vanja Ratkovic at 01 661 2206 (9 AM to 5 PM) or by email to