Study of the United Statesinstitutes for Scholars & Foreign School Educators

STUDY OF THE UNITED STATESINSTITUTES FOR SCHOLARS & FOREIGN SCHOOL EDUCATORS

SUMMER OF 2015

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APPLICATION

TITLE OF THE INSTITUTE YOU ARE APPLYING FOR

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NAME (as it appears on passport):

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DATE OF BIRTH: (Month, Day, Year)

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CITY OF BIRTH: ______

COUNTRY OF BIRTH: ______

COUNTRY OF RESIDENCE: ______

COUNTRY OF CITIZENSHIP: ______

HOME ADDRESS: ______

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HOME TELEPHONE: ______

CELL PHONE: ______

E-MAIL ADDRESS: ______

GENDER: ______

MEDICAL, PHYSICAL, DIETARY OR OTHER PERSONAL CONSIDERATIONS (Nophysicalexamination isrequiredtoparticipatein this program):

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CURRENT POSITION AND TITLE:

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CURRENT INSTITUTIONAL AFFILIATION AND COMPLETTE ADDRESS:

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WORK EXPERIENCE, INCLUDING PREVIOUS POSITIONS AND TITLES:

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EDUCATION, ACADEMIC AND PROFESSIONAL TRAINING INCLUDING DEGREES EARNED AND FIELD OF SPECIALIZATION:

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ACTIVE PROFESSIONAL MEMBERSHIPS: ______

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SHORT LIST OF RELEVANT PUBLICATIONS:(Please choose no more than five to ten of your most important publications).

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PREVIOUS EXPERIENCE IN THE UNITED STATES: (Please list all trips you have made to the United States and include approximate dates and reason for travel).

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FAMILY RESIDING IN THE UNITED SATES:

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

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EVIDENCE OF ENGLISH FLUENCY:

(Please list any English test scores you have received, if you have taken any English exams in the last three years).

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PLEASE DESCRIBE THE EXTENT OF CURRENT OR PROJECTED U.S. STUDIES COURSE CONTENT AND MATERIALS BEING TAUGHT OR DEVELOPED AT YOUR INSTITUTIONS:

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LIKELY RELEVANCE OF THE PROGRAM TO YOUR PROFESSIONAL RESPONSIBILITIES:

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THE POTENTIAL IMPACT OF YOUR PARTICIPATION ON THE DEVELOPMENT OF THE STUDY OF THE U.S. AT YOUR INSTITUTION:

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SHORT PERSONAL STATEMENT:

Tell us about yourself and your goals including the following: How do your background and/or interests make you competitive for this particular institute? What will you contribute to your academic institute? How do you expect this experience will affect your future professional career? How will it affect you personally? Please structure your essay in paragraphs and limit your response to 250 words, or approximately half a page, single spaced.