Application for Foreign Language Teaching Assistantship in the United States

FULBRIGHT PROGRAM

Application for foreign language teaching assistantship in the United States

General Information

1. NAME (as it appears or will appear on your passport)

Family First Middle

Mr.

Ms.

______

2. NAME ON PREVIOUS RECORDS (if different in content or spelling from above)

Family First Middle

3. PERMANENT MAILING ADDRESS:

Street______

City______

State/Province______Postal Code______

Country______

Telephone: ______E-mail: ______

Cellphone: ______

4. DATE OF BIRTH: (Month/Day/Year)______5. CURRENT AGE: ______

6. GENDER______7. BIRTHPLACE: (City, State/Province, Country)______

8. COUNTRY OF CITIZENSHIP______9. COUNTRY OF RESIDENCE ______

10. DO YOU NOW OR HAVE YOU EVER HELD:

U.S. CITIZENSHIP? ______

U.S. DUAL CITIZENSHIP? ______

U.S. PERMANENT RESIDENCY? ______

PLEASE SELECT ONLY ONE OF THE FOLLOWING REGARDING YOUR POSSIBLE ROLE ON A U.S. UNIVERSITY CAMPUS

11. IN MY ROLE AS A LANGUAGE ASSISTANT ON A U.S. UNIVERSITY CAMPUS, I AM WILLING TO:

_ Perform actual classroom teaching duties

_ Be primarily an assistant

_ Both teach and assist

12. WOULD YOU BE WILLING TO ACCEPT PLACEMENT IN ANY GEOGRAPHIC AREA? (limiting the regions may reduce the likelihood of final selection) Yes No

13. IF YOU WOULD BE UNWILLING TO ACCEPT PLACEMENT IN ANY GEOGRAPHIC AREA, PLEASE INDICATE WHICH REGION YOU WOULD NOT ACCEPT. (Please skip to question #14 if you selected Yes to #12 above)

Northeast Mid-Atlantic Southeast Midwest Southwest Rocky Mountain West Coast

14. WOULD YOU BE UNWILLING TO ADAPT TO ANY OF THE FOLLOWING INSTITUTIONAL PROFILES? Please select all that apply (an inability to adapt to a new or different environment may reduce the likelihood of final selection).

Single gender student body

Urban location

Rural location

Small population

Large population

Little ethnic diversity

Great ethnic diversity

Offers coursework on an audit basis

Requires specific coursework on a credit basis

N/A, I would accept all

15. OBJECTIVES: Write a clear and detailed description of your objectives.

Emphasize your qualifications, areas of expertise and career goals. Give your reasons for applying to the Program and the role you expect to have on campus.

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

Note: Please limit your response to the size of this text box. Anything over this size will not display or print on your submitted application

17. ARE YOU PURSUING ANY OTHER SCHOLARSHIP, FELLOWSHIP OR EMPLOYMENT THAT WOULD SUPERCEDE YOUR PARTICIPATION IN THE FLTA PROGRAM SHOULD IT BE OFFERED? PLEASE EXPLAIN:

Note: Please limit your response to the size of this text box. Anything over this size will not display or print on your submitted application

18. DEGREE: PLEASE INDICATE THE LAST DEGREE YOU COMPLETED. PLEASE DO NOT LIST CERTIFICATES IN THIS SECTION.

Degree (ex. Masters, Bachelors) or Equivalent (ex. Magister, Maestria, Bakkalaureus, Maîtrise) / In What Field (please list the field of study as it appears on the degree)

19. EDUCATION: LIST EDUCATIONAL INSTITUTIONS ATTENDED IN REVERSE CHRONOLOGICAL ORDER, INCLUDING ANY IN WHICH YOU MAY BE PRESENTLY ENROLLED.

Name of Institution/Location / Major Field of Study / Dates (Month and year)
From To / Actual Name
of Degree or
Diploma (Do not translate) / Date Received
or Expected

University or Professional

Secondary

20. LIST SCHOLARSHIPS OR FELLOWSHIPS HELD AT PRESENT OR IN THE PAST. GIVE SOURCE OR SPONSOR, AMOUNT, WHERE HELD, DURATION AND YEAR. Note: Please limit your response to the size of this text box. Anything over this size will not display or print on your submitted application.

21. INDICATE ACADEMIC HONORS OR PRIZES WHICH YOU HAVE RECEIVED. Note: Please limit your response to the size of this text box. Anything over this size will not display or print on your submitted application.

22. OCCUPATIONAL EXPERIENCE: CLEARLY INDICATE YOUR EMPLOYMENT HISTORY, BEGINNING WITH YOUR MOST RECENT POSITION. YOU MUST COMPLETE ALL RELEVANT FIELDS.

Name and address of employer / Type of Work
(Position Held) / Dates / Reason for leaving
Note: If position still held, please note as “ongoing”
From / To

23. TEACHING EXPERIENCE: IF YOU CURRENTLY OR PREVIOUSLY HELD A LANGUAGE TEACHING POSITION, PLEASE ESTIMATE THE NUMBER OF MONTHS OR YEARS YOU OCCUPIED THE POST? ______Months Years

24. LIST PROFESSIONAL SOCIETIES, FRATERNITIES 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) Note: Please limit your response to the size of this text box. Anything over this size will not display or print on your submitted application.

25. IF YOU HAVE TRAVELED OR LIVED IN ANY COUNTRY OTHER THAN YOUR OWN INDICATE PLACES, DATES AND REASONS. Note: Please limit your response to the size of this text box. Anything over this size will not display or print on your submitted application.

26. LANGUAGE SKILLS: Please respond to all of the following fields even if Mother Tongue and Language of Nomination are the same. Please indicate N/A if any of the following fields are not applicable.

Category Name of Language Proficient (Excellent, Good, Fair Poor)

Language of Nomination
Mother Tongue
Second Language
Third Language

27. Examination Results: Recommended: Research next available exam dates if you don’t already have scores:

TOEFL Date Taken/To be Taken

Month/Year ______Test ______Score ______

IELTS Date Taken/To be Taken

Month/Year ______Test ______Score ______

Candidacy will not be finalized until English language proficiency scores are received. Please inquire with your home country contact regarding TOEFL vouchers. There are no IELTS vouchers available. Your home country contact for the FLTA Program can be located at http://www.flta.fulbrightonline.org/thinking_apply_now.html .

28. Provide the name, address and telephone number of individuals to be notified in case of emergency

In Home Country / In the United States / List Below any close relatives or friends in the United States (name, address, and relationship)

29. COURSE INTEREST: The FLTA Program is a non-degree program. You will be expected to take one course in American Studies and three additional courses at your host institution on a credit or audit basis for enrichment purposes. Name three courses you may be interested in taking and why?

Course / Reason
1.
2.
3.

30. TEACHING THE LANGUAGE OF NOMINATION: You may be asked to teach your own class. If so, what teaching methodologies and techniques would you apply to the teaching of the language for which you have been nominated? Mention any innovative approaches you have utilized as a teacher or encountered as a learner that you may employ.

31. SHARING YOUR CULTURE: Imagine you have to represent your country at an International Festival your host school is organizing. What aspects of your language and culture would you choose to present?

32. Personal Statement:

Please write a narrative concerning your personal history and long-term goals; it should not be a mere listing of facts, nor should it be a copy of the essay provided in #14 of this application. Please see the "Tips" in the Instructions before submitting your essay.

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. If not in English, then an accurate translation must be attached.

Name of Applicant

Country ISRAEL

Name of Referee

1. How long have you known the applicant?

2. In what capacity have you known the applicant?

Teacher or Professor q Employer or Job Supervisor q

School Counselor q Other (please specify)

3. Please provide a candid evaluation of the applicant’s past performance and ability to pursue and successfully complete a teaching assistantship in the United States. Your statement will be given considerable importance by the American universities/colleges reviewing this application, 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 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

Signature Date

This reference must be received by the United State-Israel Educational Foundation by the end of working hours on

January 5, 2009.

Please mail the reference directly to USIEF,

P.O. Box 26160, Tel Aviv 61261, or transmit it by fax to 03-516-2016.

CONFIDENTIAL LETTER OF REFERENCE

Name of Applicant

Country ISRAEL

Name of Referee

1. How long have you known the applicant?

2. In what capacity have you known the applicant?

Teacher or Professor q Employer or Job Supervisor q

School Counselor q Other (please specify)

CONFIDENTIAL LETTER OF REFERENCE FOR (continued)

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

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

Signature Date

This reference must be received by the United State-Israel Educational Foundation by the end of working hours on

January 5, 2009.

Please mail the reference directly to USIEF,

P.O. Box 26160, Tel Aviv 61261, or transmit it by fax to 03-516-2016.

CONFIDENTIAL LETTER OF REFERENCE

Name of Applicant

Country ISRAEL

Name of Referee

1. How long have you known the applicant?

2. In what capacity have you known the applicant?

Teacher or Professor q Employer or Job Supervisor q

School Counselor q Other (please specify)

CONFIDENTIAL LETTER OF REFERENCE FOR (continued)

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

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

Signature Date