UNITED STATES-INDIA EDUCATIONAL FOUNDATION

12 Hailey Road, New Delhi 110 001

Preliminary Application Form

for

2015-2016 Fulbright-Nehru International Education Administrators Seminar

Application Instructions

Please read these instructions carefully:

All applications must be computer generated. Handwritten or typed applications will not be accepted. Please do not exceed the word limit or attach additional pages to answer questions, unless otherwise specified.

1.  Please submit a hard copy of your completed application to USIEF, 12 Hailey Road, New Delhi 110 001 along with all the attachments (please refer to the application checklist). Please write ATTN: Fulbright-Nehru International Education Administrators Seminar on the envelope.

2.  Print a copy of your application with the attachments and sign it. Please forward the signed copy of your application with attachments through proper channel (please refer to item # 16 of the application form) so as to reach USIEF office by the application deadline.

3.  You are advised to request three referees to send their recommendations on the prescribed Reference Report Forms to the Executive Director, USIEF, 12 Hailey Road, New Delhi 110 001 no later than the application deadline. These forms can be downloaded from the USIEF website www.usief.org.in

Application Deadline: March 31, 2015

Warning: Plagiarism in the application will lead to disqualification.

APPLICATION CHECKLIST

A complete application should include:

·  Application Form

·  Project Statement (Attachment A)

·  Institutional Statement (Attachment B)

·  Curriculum Vitae/Resume (Attachment C)

·  Three Reference Reports (Referees will send these to USIEF directly)

UNITED STATES-INDIA EDUCATIONAL FOUNDATION

12 Hailey Road, New Delhi 110 001

Preliminary Application Form

2015 – 2016 Fulbright-Nehru International Education Administrators Seminar

[Application must be computer generated]

1. Name:

[Surname/Family Name] [First Name] [Middle Name]

2. Gender: Male Female Marital Status: Single Married

3. Date of Birth [dd/mm/yy]: Age: Place of Birth:

4. Country of Citizenship:

5. Designation, Name of the Organization and Address:

Phone: [Office] [Home] [E-mail]

6. (a) Academic Qualifications [Enter your highest degree first]:

Degree / Major Field of Specialization / Institution / Dates Attended (mm/yy)
[From – To]

(b) Major Academic Discipline (if applicable):

7.  Work Experience [begin with the latest]:

Designation/Title / Organization / Dates Attended (mm/yy)
[From-To]

8. Most significant professional accomplishments, honors, and awards:

9.  Project Statement: Your Project Statement should be 2-3 pages in length. Please use Arial 10-pt font. It should be submitted along with this application as Attachment A. Your project statement should address the following:

·  Your current job responsibilities and how they relate to this program. Highlight your experience in international education activities;

·  Why would you like to participate in this program? How will learning about U.S. college and university education be of help to you and to your home institution, and/or community; and

·  How will you share what you have learned with your home institution and others?

10.  Institutional Statement: The Institutional Statement should be 1-2 pages in length. Please use Arial 10-pt font. It should be submitted along with this application as Attachment B. It should address the following:

·  General information about your home institution (type of institution, total enrolment, number of diplomas/degrees offered, etc.);

·  The number of international students on campus and where they are coming from;

·  Any institutional partnerships/MoUs with institutions abroad; and

·  Your home institution’s future goals/plans for enhancing its international dimension and for building capacity of its faculty and students through international collaborations and exchange and innovative curricular design.

11. Curriculum Vitae/Resume: It should be submitted along with this application as Attachment C. Please do not exceed 6 pages.

12. Publications: List two principal publications with title, publication date and publisher's name.

13. Have you travelled abroad? If so, please provide the following details:

Country / Dates / Purpose / Sponsorship

14. Professional Memberships (cultural, educational and professional organizations).

Organization / Your Role / Duration

15. Recommendations: List below names of three referees with their designation and contact details. Referees should be requested to complete the prescribed Reference Report Form and mail it directly to the Executive Director, USIEF, 12 Hailey Road, New Delhi 110 001, so as to reach by the application deadline.

1.

2.

3.

16. Employer's Comments [This column must be filled-in by the Administrative Head (Vice Chancellor/Registrar/Principal/Director) of the institution and not the immediate supervisor or head of the department.] No application will be considered complete unless forwarded through the proper channel. Please indicate whether the applicant, if selected, will receive leave for the grant period.

Employer's Signature :

Official Seal: Name :

Date (dd/mm/yy): Designation :

17. Home Address:

Phone: [Home] [Mobile] [E-mail]

18. Indicate preferred mailing address (please tick any one): Office Home

19. Do you have a valid passport? Yes No

If yes, please mention: Passport No. Date of Expiry (dd/mm/yy):

20. Please list your extra-curricular activities:

21. How did you learn about the Fulbright Program? [Please indicate all that apply]

Friend or relative / University (specify) / USIEF Website
Previous Fulbrighter / Newspaper (specify) / Internet Link
Poster/Flyer / Other Publication (specify) / Other (specify)
Fulbright Presentation (specify)

22. Please read carefully and sign:

I confirm that I have reviewed the General Prerequisites for all Fulbright applicants and any specific guidelines pertaining to the Fulbright-Nehru International Education Administrators Seminar.

I understand that any incomplete application, or application falsified by omission or misinformation will automatically be disqualified.

I agree to inform USIEF about any overseas travel plans during the application cycle (January 2015 to September 2015)

I understand that initial selection in India does not guarantee me an award.

I also understand and agree that if a grant is awarded to me, I will abide by the policy guidelines established by the J. William Fulbright Foreign Scholarship Board in connection with the grant.

Date (dd/mm/yy) Name and Signature of the Applicant

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