FAX & EMAIL COPIES ACCEPTED

(808) 944-7070 |

Focus on Indonesia: Exploring Global and Curriculum Connections

Fulbright-Hays Group Projects Abroad Program
July 5 – August 6, 2010

This form is also available online at: Print or type your answers. Do not write in shaded areas.

PART 1: PARTICIPANT INFORMATION
Family name Given name Middle name(s) Other name(s) / Sex
 Male
 Female
Complete current mailing address including street and apt. #, city, state/country, postal/zip code / Address valid until: (month/year)
E-mail address / Home phone including area code / Cell phone including area code
How did you learn about this program?
Have you previously participated in an AsiaPacificEd or other East-WestCenter programs? If you have, specify year and program name(s).
PART 2: SCHOOL CONTACT INFORMATION
School name
Street address / City / State / Zip code
School website address / School phone, including area code Fax including area code
Type of institution/school
Public Private Urban Suburban Rural
Number of students in applicant’s school / Number of teachers in applicant’s school
TEACHING EXPERIENCE (beginning with current school):
Subject(s) & grade level(s) taught
Starting with 2008-2009 school year / No. of students taught / School name / City/State / Years at the school
EDUCATION: List in order of your attendance all colleges/universities in which you have enrolled. Include the one in which you are currently enrolled, if applicable. (Begin with the most recent.)

Name of institution

/ Location
(city and state) / Date
From To
mm/yy mm/yy / Major / Degree or Diploma rec’d / Date rec'd
OTHER TRAVEL STUDY EXPERIENCES
Program name / Year / Sponsoring organization & contact person / Country/Countries visited / Length of program
ADDITIONAL REQUIREMENTS:
  1. A statement of purpose: Please describe your professional background, what special perspective, skills and/or experiences that would contribute to the program, and how the experience would enhance your teaching or school service. Your statement of purpose must be typed (one or two pages, double or single-spaced, using font size not smaller than 11 pt and not larger than 12 pt; Times New Roman preferred).
  1. A reference (use form supplied on website: teachers, the reference may be from your school principal, a department chair, or a teacher colleague. For principals, the reference must be from a teacher at your school. It is the applicant’s responsibility to ask the referee to send the reference form directly to the East-West Center and to make certain that it is received by the application deadline (March 22, 2010).
CHECKLIST OF APPLICATION MATERIALSThe following items constitute a complete application:

A completed and signed application form (typed or printed)

Your statement of purpose (must be typed)

A reference sent by your referee to the East-WestCenter and to make certain that the letter is received by the application deadline (March 22, 2010).

Check here if you intend to participate in the Bali add-on program.

SUBMISSION OF APPLICATION

By email:

By mail: Focus On Indonesia

______AsiaPacificEd Program/East-West Center

1601 East-West Road

Honolulu, HI96848
The application materials must be received at the East-WestCenter by March 22, 2010.

By fax: (808) 944-7070
The faxed application to the East-WestCenter must be received no later than March 22, 2010.
Applicants will be notified of selection sometime between March 23-31, 2010, pending funding decision.

THE EAST-WESTCENTER

The U.S. Congress established the East-WestCenter in 1960 with a mandate to "promote better relations and understanding between the United States and the nations of Asia and the Pacific through cooperative study, training, and research." Under the leadership of an international Board of Governors, theEast-WestCenter works to promote a stable, peaceful, and prosperous Asia Pacific community wherein the United States is a natural and valued partner.

A major effort at the East-WestCenter has been to help infuse studies of the Asia Pacific region into the curricula of U.S. schools by supporting the professional development of school educators. Through its education programs, the Center works closely with public, private, parochial, and charter elementary and secondary schools as well as colleges and universities nationwide to better prepare the United States for an era of much greater interaction with the Asia Pacific region.

As a public, nonprofit corporation, the Center receives core funding for its programs from a U.S. government appropriation. Additional support comes from foundations, international agencies, Asia Pacific government entities, corporations, and private individuals.

APPLICANT'S CERTIFICATION

I hereby certify that the information I have given on this application is complete and correct to the best of my knowledge.

Signature of Applicant: ______Date: ______

AsiaPacificEd Program, East-WestCenter | htt:// | 1601 East-West Road, Honolulu, HI96848 | Tel: (808) 944 7378 | Fax: (808) 944 7070