E-Teacher Scholarship Program
APPLICATION FORM
PUBLIC AFFAIRS SECTION, U.S. EMBASSY
E-mail:
Please submit the completed request form to the email address above by November 20, 2013.
In the subject line please indicate the name of the program
“E-Teacher Scholarship Program 2013-14” and your last name.
1. CONTACT INFORMATION
FIRST NAME: LAST NAME: TITLE/POSITION: INSTITUTION NAME: PRIMARY E-MAIL ADDRESS:
SECONDARY E-MAIL ADDRESS:
CELL PHONE NUMBER: MAILING ADDRESS: POSTAL INDEX:
2. SELECTED COURSE TITLE:
(Please underline the selected course title)
A. Introduction to Pedagogy and Practices for Teaching English to Speakers of Other
Languages (TESOL Methods)
B. Building Teaching Skills through the Interactive Web (Web Skills) C. Practical Applications in Language and Learning Skills (PALSS)
D. Teaching English to Young Learners (TEYL)
E. Teaching English to Pre-teens and Teens (TEPT)
F. English for Specific Purposes, Aligning Context with Practices and Materials (ESP) G. Special Education and Differentiated Instruction in EFL Contexts (SpEd EFL)
H. Summative and Formative Assessment in Language Learning and Teaching
(Assessment)
I. Critical Thinking in Language Learning and Teaching (CT)
3. REASONS FOR YOUR PARTICIPATION
Briefly explain why participation in the course is important for you and how and where you are going to share the gained knowledge. Please give specific examples as to why this particular topic is relevant to your teaching. Please indicate your level of English, the number of years you have taught, and the age group of your students.
4. PLEASE CONFIRM THAT YOU MEET THE REQUIREMENTS OF THE PROGRAM BY CHECKING THE BOXES BELOW:
Yes, I have regular and reliable access to high-speed Internet connection
Yes, I have required English language reading and writing/typing skills
Yes, I commit to spending 10-15 hours a week on-line to participate in the course
Yes, I commit to share the gained knowledge through making presentations in my region and at the Embassy initiated events in other regions of Georgia