INSTITUTE OF SM

INTERNATIONAL OPENING MINDS TO THE WORLD

EDUCATION

The Voice of America Scholarship Program Application

Name of applicant

EXACTLY AS APPEARS IN ID or PASSPORT

Last/Family Name: First:

中文姓名：

Male Female

______

Present Address (Street address and number; city, province)

中文地址：

Email:

Present telephone number ______

Permanent Address (Street address and number; city, province)

Permanent telephone number______

Place of birth (city or town and country)______

Date of birth (month/day/year)______

Country of Citizenship______

Country of Residence______

First Language______

Area(s) of academic concentration/major you hope to pursue in the U.S.:

English Language Proficiency

If you have taken any standard test of English language proficiency, please attach copy of the

test results. TOEFL results are preferred.

Test Taken______Date Taken______Results (Please attach copy)______

EDUCATION: LIST EDUCATIONAL INSTITUTIONS ATTENDED. PLEASE INCLUDE A COPY OF EACH DIPLOMA OR CERTIFICATE.

Name of Institution/Location / Major Field of Study / Dates (Month and year)
From To / Actual Name
of Degree or
Diploma /

Date Received

or Expected
University
Secondary
LIST SCHOLARSHIPS OR FELLOWSHIPS HELD AT PRESENT OR IN THE PAST:

(Give source or sponsor, amount, where held, and duration and year)

INDICATE ACADEMIC HONORS WHICH YOU HAVE RECEIVED (beginning with high school):

Have you completed a degree abroad?

Yes No

If yes:

Degree Name:

Date of Completion: (month/year)

Institution Name (Country):

OCCUPATIONAL EXPERIENCE: LIST POSITIONS HELD (begin with most recent employment, if any)

Name and address of Employer Type of Work

(Position Held) Dates Reason for leaving

LIST PROFESSIONAL SOCIETIES OR OTHER ORGANIZATIONS IN WHICH YOU NOW HOLD MEMBERSHIP OR IN WHICH YOU HAVE BEEN ACTIVE IN THE PAST (Indicate if you have held elective office)

OBJECTIVES: Write a clear and detailed description of your objectives. Give reasons for wanting to participate in the VOA Scholarship Program. Explain how the program fits with your previous education/training and your future objectives, and what is your desire to enhance relations between the United States and China. Describe your future plans. THIS STATEMENT IS AN IMPORTANT PART OF YOUR APPLICATION.

NON-ACADEMIC INTERESTS: Please list any non-academic interests (e.g. sports, music, art, etc) Include information about your experience in these areas.

IF YOU HAVE TRAVELED OR LIVED IN ANY COUNTRY OTHER THAN YOUR OWN

INDICATE PLACES, DATES AND REASONS.

Family Information:

Mother’s full name （中英文）:

Telephone Number:

Address:

Father’s full name （中英文）:

Telephone Number:

Address:

______

Please provide the name, address and telephone number of individuals to be notified in case of emergency

(name, phone number, address, and relationship)

______

Please describe any physical impairment you may have (This information is gathered for statistical purposes and to ensure appropriate placement. The program does not discriminate on the basis of race, color, religion, sex, national origin, and/or physical impairment)

______

Please provide extracurricular and volunteer activities you have participated in (including summer)

Biographical Essay

This short essay should describe some of the major events in your life. You should discuss where you were born, your family and other important figures who have shaped the person you have become. Please limit your response to 500 words or less.

PERSONAL STATEMENT

The statement should be a narrative statement concerning your personal history and future plans. It should include information about your background education, practical experience, special interests, career plans, and your purpose in applying for this program. Describe any significant influences on your personal and educational development. Comment on the number of years of practical experience already completed in your field and describe briefly the most advanced courses already pursued. You may want to include the following topics:

1, Why do you choose Journalism/Media Studies as your major?

2, What passion do you have on the Journalism/Media profession?

3, Evaluate a significant experience, achievement, or risk that you have taken and its impact on you.

4, Discuss some issue of personal, local, national, or international concern and its importance to you.

5, Indicate a person who has had a significant influence on you, and describe that influence.

You may attach your essay on separate sheets.

SIGNATURE:

My signature below indicates that all information in my application is complete, factually correct, and honestly presented.

Signature ______Date ______

CONFIDENTIAL LETTER OF REFERENCE

Two Letters of Reference should be written by teachers under whom you have studied or pursued research or by someone who has supervised you in work or other relevant activities. Letters of Reference should not be written by persons related to you either by blood or marriage, or by personal friends. The letters should be written in English or Chinese and returned directly to the applicant in sealed envelopes. Please refer to the forms attached.

CONFIDENTIAL LETTER OF REFERENCE

This letter of reference must be written by a teacher under whom the applicant has studied or by someone who has supervised the applicant in work, athletics or other relevant activity. This letter must be in English.

Name of Applicant ______

Name of Referee ______

1. How long have you known the applicant?

2. In what capacity have you known the applicant?

Teacher or Professor  Employer or Job Supervisor 

School Counselor  Other (please specify) ______

3. Please provide a candid evaluation of the applicant’s past performance and ability to pursue and successfully complete a training program in the United States. Your statement will be given considerable importance and should, therefore, be as complete and detailed as possible.

CONFIDENTIAL LETTER OF REFERENCE FOR______(continued)

4. In the rating chart below please evaluate the applicant in comparison with other students/employees whom you have known during your professional career.

Excellent / Very Good / Average / Below Average
Creative
Motivation
Self-confidence
Independence, initiative
Intellectual ability
Academic achievement
Disciplined work habits
Adaptability to New Situations
Leadership Qualities
Potential for growth

5.Please indicate where the applicant would rank among students/employees currently or recently in your department/organization.

95% 90% 75% 50% 25%

TOP BOTTOM

Name and Title (print)______

School, Company or Organization______

Contact Information: Tel:______Email:______

Signature ______Date ______

Please return directly to the applicant in a sealed envelope.

保密推荐信

本信须由曾为申请人授课的教师、曾主管过申请人工作或从事其他活动的人士填写。写好后请放入信封封好后交给申请人。

申请人姓名：

推荐人姓名：

1，  请问您认识申请人多长时间了？

2，  通过何种方式认识申请人：

□ 作为任课教师或教授 □ 作为学校辅导员

□ 作为雇主或主管 □ 其他（请注明）

3，  请附纸就申请人的过去表现和在所申请的领域求学并完成学业的能力作出坦诚的评估。您的陈述将对申请人的录取起到重要作用，请尽可能详尽表述。

4，  请根据与您职业生涯中接触的其他学生进行对比，在下表中对申请人做出评价。

非常好 / 好 / 一般 / 较差
智力水平
工作习惯
申请此学习项目的动机
对目标的严肃程度
在所申请的学习领域做出重大贡献的潜力
资源延展性
情感成熟度
对新环境的适应性
领导能力

5，  请标示出申请人在您所在院系学生中的排名情况。

95% 90% 75% 50% 25%

│ 排名靠前 ←│→ 排名靠后 │

填写人的姓名和职务：

所在单位：

联系电话：

签名： 日期：

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