2013Study in the United States SummerInstitute

Application Form

Indicate Institute(Please indicate ONLY ONE Institute, otherwise your application will not be considered):

U.S. Culture and Society

American Politics and Political Thought

Contemporary American Literature

U.S. Foreign Policy

Journalism and Media

Religious Pluralism in the United States

Study of the United States Institutes for Secondary School Educators

Personal Information:

Family Name / First Name / Patronymic / Title (Dr./Mr./Mrs./Prof.)
(NOTE: AS IT APPEARS IN HIS/HER PASSPORT.)
Date of Birth (MM/DD/YYYY) / City of Birth / Country of Birth
Country of Residence / Country(ies) of Citizenship
Home Address
Cell phone / Home Telephone / E-mail
(NOTE: Please include the telephone code for your city or region.)
Male / Female
Medical, Physical, Dietary or other Personal Considerations:
Professional Information:
Current Position and Title / Department
Institution
Address
City
Telephone / Fax
Work experience, most recent first:
Institution/Employer / Position / Dates of Employment
Education, Academic and Professional Training, most recent first:
Degrees/Fields of Specialization / Institution / Date
Active professional memberships AND additional professional training:
Short List of Relevant Publications (maximum 10 publications): Publications should include the publication year, type of publication, title, and publisher. All foreign titles should be translated into English. To identify the publication type, please choose from among the following options: 1) book; 2) edited volume (as primary or co-editor); 3) book chapter; 4) journal article; 5) newspaper/online article; 6) conference/university/government working paper.
U.S. Travel:
Purpose / Date / USG-funded
Yes No
Yes No
Yes No
Yes No
  1. 17.
/ Family Residing in the United States: Please list any immediate family members who are currently residing in the United States, including city and state:
English Proficiency:
Reading: / Excellent / Good / Fair
Writing: / Excellent / Good / Fair
Speaking / Excellent / Good / Fair
  1. Professional responsibilities:

Current Courses taught – Please include the course title, level of students (Ph.D., M.A., Undergraduate, High School), and the number of advising hours.

Current Student Advising – Please include the number of students advised who are studying U.S. related topics, level of students (Ph.D., M.A., Undergraduate, High School), and the number of advising hours.

Other Potential Outcomes – Pleaseselect all of the likely potential outcomes that might result from your participation in this institute:

Update Existing Course;

Create New Course;

Create New Degree Program

University Curriculum Redesign;

National Curriculum Redesign;

New Research Project;

New Publication;

Professional Promotion;

Government or Ministry Policy;

New Professional Organization;

New Institutional Linkages;

Raise Institutional Profile.

Please explain each point marked.

  1. Personal Essay, limit 250 words.

Please discuss how your participation would enhance your personal and professional goals, the current state of U.S. studies in your home country, or upon the Institute. Include how attending this Institute would help you achieve the “Other Potential Outcomes” you have checked above.

Applications without essays will not be considered.

Completed applications may be sent by e-mail:

Application deadline: December 10, 2012

Please phone (495) 728-52-42 if you have any questions.