1. PERSONAL INFORMATION
Last Name: / First Name:
Citizenship: / ArgentineanNot Argentinean / Gender: / femalemale
Birth Date(mm/dd/yyyy): / Age:
Marital Status: / singlemarriedseparated / DNI:
Street:
City: / Province: / Select a ProvinceOut of ArgentinaBuenos AiresCapital FederalCatamarcaCórdobaChacoChubutCorrientesEntre RíosFormosaJujuyLa PampaLa RiojaMendozaNeuquénRío NegroSaltaSanta CruzSantiago del EsteroSanta FeSan JuanSan LuisTierra del FuegoTucumán
Zip Code: / Country: / ArgentinaOut of Argentina
Note: Your contact information must be a current address
Phone (Home): / E-mail:
Phone (Work): / Phone (Mobile):

How did you learn about this grant opportunity?

2. EDUCATION AND PROFESSIONAL EXPERIENCE
A. Universities Attended
List most recent institutions attended above high school
Name of Institution / Location
(city, province) / Dates attended(mm/yy - mm/yy) / Degree
(in Spanish) / Grade Average

University Degree received on(mm/dd/yyyy):

B. English Exam Score

Note: If you are going to take an English test, complete the Type and Date fields and leave the Score field empty.

Type:

Date(mm/dd/yyyy): Score:

C. Publications, Prizes and Recognitions

Do you have any publications (books, articles) in your proposed field of study?:

If the answer is "Yes", please specify below indicating title, place and date of publication.
(Max. 500 characters with spaces)

Have you received any academic honors or awards?:

If the answer is "Yes", please specify below indicating titles and dates.
(Max. 500 characterswith spaces)

Did you have other scholarships in the past?:

If the answer is "Yes", please specify below indicating source or sponsor, amount, where held, and duration.
(Max. 500 characterswith spaces)

D. Teaching, Work or Research Experience

List your most relevant teaching work or research positions

Employer / Dates (mm/yy - mm/yy) / Position (in Spanish)

Identify your current position or occupation: (e.g.: Journalist)

Gross monthly income in pesos(to be used only for internal statistics):

3. COMPLEMENTARY INFORMATION
A. Have you applied for or have been granted any other scholarship for the same period?

If the answer is "Yes", please specify below.

No.Yes.
B. Do you have previous experience in the United States?

If the answer is "Yes", please specify below.

No.Yes.
C. Study Plans

What is your major field of study?:

Please, mention your subfield or specialization:

Future Plans:

Describe the career you plan to pursue after completion of study / research in the U.S., e.g. teaching, business, industry or any plans you might have for continued study or research in your home country. Also indicate if you will be returning to former employment, or if you have been promised a position in your home country after completing your U.S. training (Max. 2500 characters with spaces) .

D. References
Full Name / Position and Mail / Organization/ Address
4. ESSAYS
A. Study / Research Objectives

Write a clear and detailed description of your study/research objectives, and give your reasons for wanting to pursue them. Be specific about your major field and your specialized interests within this field. Explain how your study plan fits in with your previous training and your future objectives. This statement is an essential part of your application and is required.(Max. 7500 characters with spaces)

B. Personal Statement

This personal statement should be a narrative statement describing how you have achieved your current goals. It should not be a mere listing of facts. It should include information about your education, practical experience, special interests, and career plans. Describe any significant factors that have influenced your educational or professional development. Comment on the number of years of practical experience already completed in the field in which academic work will be done in the U.S.(Max. 7500 characters with spaces)

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