DAP Bewerbungsbogen/Participant Application

DAP Bewerbungsbogen/Participant Application

ATTACH

PHOTO

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Personal Information

Family (Last) Name: / First Name: / Middle Name:
Birth Date / Birth City / Birth Country
Country of Citizenship / Country of Residency
Gender / Marital Status / Status
Male Female / Single Married / Student Non-Student

Contact Information – Current Address

Street & Number / City / Postal Code
State / Country
Home Phone / Mobile Phone / Email

Permanent Address

Street & Number / City / Postal Code
State / Country
Home Phone / Mobile Phone / Email

Emergency Contact

In case of an emergency please provide us with information on who to contact:

First Name / Last Name / Relationship
Street & Number / City / Postal Code
State / Country
Home Phone / Mobile Phone / Email

U.S. Host Company

How did you learn of the position with your host company?

Host Company Name
Start Date / End Date
Street / City/State
Name of Contact Person / Phone / Email

Visa Sponsor

Visa Sponsor / Type of Visa

Language Ability

English Proficiency
Fluent Good Fair Poor /

Languages other than English

Education

Please list the school in which you are currently enrolled, or from which you most recently graduated. Do not list primary or secondary schools. You may then add new records for additional schools.

Dates of Attendance / University/College Name / Areas of Study / Degrees/Certificates Received

Employment experience

List your current employer or activity first. Your most recent work experience(s) must be within the past 12 months.

Dates of Employment / Position Title / Company Name & Location / Job Responsibilities

Previous Travel to the United States

Have you previously visited the United States on a non-tourist visa? Yes No

If yes, please answer the following:

Date of Entry / Date of Departure
Type of Visa / Purpose of Visit

Which organization sponsored you?

Have you ever been refused a visa to the United States? Yes No

If yes, please explain the reason for refusal, type of visa requested and the date of refusal:

Financial Information

Personal funds

Essay

Please respond in complete sentences and in English. Each response should be 250 words or less.

What specific skills do you hope to learn in the United States that you would not learn in your home country?
How will this program benefit you in terms of career development and international cultural understanding?
What are your long term goals?
Besides professional skills, what do you hope to gain from this internship?

Application checklist

Ø  Signed and completed participant application

Ø  Essay

Ø  German Resume

Ø  American Resume

Ø  Photocopy of a valid passport photo page and name/issuance page

Ø  Bank information document

Ø  If you are a student: certificate of enrollment/study

Ø  Copy of most recent certificate or diploma

I have read and fully understand the questions asked in this application. I certify that all statements made by me in this application are true and correct.

______

Printed Name Signature

______Date

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