FULBRIGHT

IfIlItIaI
FOREIGN FULBRIGHT GRANT APPLICATION COVER SHEET

Name:____________________________________________________________________ Family First Middle

PERMANENT ADDRESS: EMAIL ADDRESS: COUNTRY OF CURRENT CITIZENSHIP____________________________________________________ COUNTRY OF BIRTH______________________DATE OF BIRTH _____/_____/____ GENDER:_________________________________CURRENT OCCUPATION:_____________________ MOST RECENT EMPLOYER:______________________________________________________________ FROM
/

TO /_________

ACADEMIC DEGREES
Degree:_______________________Field of Study:_________________________________________________

SCHOLARSHIPS TEACHING EXPERIENCE: If you currently or previously held a language teaching position, please estimate how long you occupied the post.

Years ________________ LANGUAGE SKILLS:

Months _____________

Not Applicable

What language are you applying to teach/assist in the U.S.?____________________________

INSTITUTEOF INTERNATIO NALEDUC ATION

General Information

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FULBRIGHT PROGRAM

Application for foreign language teaching assistantship in the United States

1. APPLICANT NAME SUBMISSION: The first, middle and last (family) name provided on this application should be spelled exactly as it appears in your passport. If you do not have a passport, you should submit the first, middle and last name spelling that would likely appear on your passport. Do you currently have a passport?_________________ 2. N A M E ( A s i t a p p e a r s o r w i l Last a p p e a r l (Family) oFirst y o u r n p a s s p o r t )
Middle Address all inquires about this candidate to: Institute of International Education
Foreign Language Teaching Assistant (FLTA) Program

3. PERMANENT MAILING ADDRESS:

Street City State (USA) Postal Code Country Telephone: E-mail: ( State/Province (outside USA)

809 United Nations Plaza New York, NY 1001 E-mail: FLTA@iie.org

) 5.

4. DATE OF BIRTH: (Month/Day/Year) CURRENT AGE 6. GENDER 8. 9. 8. COUNTRY OF RESIDENCE COUNTRY OF CITIZENSHIP 1 9 .

7. BIRTHPLACE: (City, State/Province, Country)

State (if USA)

State/Province (outside USA)

11.

10. DO YOU NOW HAVE, OR HAVE YOU EVER HELD:

U.S. CITIZENSHIP? U.S. DUAL CITIZENSHIP? U.S. PERMANENT RESIDENCY?

HAVE YOU EVER APPLIED FOR U.S. PERMANENT RESIDENCY (i.e. green card)?__________

My application was denied My application is still pending

PLEASE SELECT ONLY ONE OF THE FOLLOWING REGARDING YOUR POSSIBLE ROLE ON A U.S. UNIVERSITY CAMPUS 11. IN YOUR ROLE AS A LANGUAGE ASSISTANT ON A U.S. UNIVERSITY CAMPUS, YOU ARE WILLING TO:

12. IS THERE A PARTICULAR REGION IN THE U.S. THAT INTERESTS YOU? 13. IF THERE IS A SPECIFIC REGION THAT INTERESTS YOU, PLEASE INDICATE IT HERE. IF THERE IS NOT A SPECIFIC REGION, PLEASE INSERT N/A. 14. WOULD NOT BE ACCEPTABLE? IS THERE ANY COLLEGE OR UNIVERSITY CHARACTERISTIC WHICH

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

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16. NON-ACADEMIC INTERESTS: PLEASE LIST ANY NON-ACADEMIC INTERESTS (e.g. SPORTS, MUSIC, ART, ETC.). INCLUDE INFORMATION ABOUT YOUR EXPERIENCE IN THESE AREAS.

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:

18. DEGREE: PLEASE INDICATE THE LAST DEGREE YOU COMPLETED. PLEASE DO NOT LIST

CERTIFICATES IN THIS SECTION. Degree Name (Masters, Bachelors)

Field of Study

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
/ /

Degree or Diploma Name

Date Received or Expected

/ /

/ /

/ /

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20. LIST SCHOLARSHIPS OR FELLOWSHIPS HELD AT PRESENT OR IN THE PAST. GIVE SOURCE OR SPONSOR, AMOUNT, WHERE HELD, DURATION, AND YEAR.

20. INDICATE ACADEMIC HONORS OR PRIZES WHICH YOU HAVE RECEIVED.

21. OCCUPATIONAL EXPERIENCE: IDENTIFY YOUR CURRENT POSITION OR OCCUPATION (Select the position title which best describes the activity in which you are currently involved.) _________________________________________________________________________ If you selected Teacher as occupation, please specify the subject(s) you teach: If you selected Other as occupation, please specify: _ LIST POSITIONS HELD (begin with most recent employment, if any.)
Name and address of Employer Type of Work (Position Held) Reason for leaving
/

Dates
/

21. TEACHING EXPERIENCE: IF YOU CURRENTLY OR PREVIOUSLY HELD A LANGUAGE TEACHING POSITION, PLEASE ESTIMATE HOW LONG YOU OCCUPIED THE POST. _______Years ______Months _______Not Applicable

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 an elective office.

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25. IF YOU HAVE TRAVELED OR LIVED IN ANY COUNTRY OTHER THAN YOUR OWN, INDICATE PLACES, DATES, AND REASONS.

25. LANGUAGE SKILLS: Please respond to all of the following fields. What language are you applying to teach/assist in the U.S.?_______________________________________ Category Name of Language Proficient (Skill Level)
Host Country Language: Mo t h er T o n g u e: S ec o n d L a n g u ag e: Third Language:

27. Examination Results: Name of Exam TOEFL IEFLTS Date Taken/To be Taken
/ /

Score

Other Test Taken Date Taken/To be Taken

/

Score

28. Provide the name, address, and telephone number of individuals to be notified in case of emergency. In Your Home Country
Family_______________________________First _______________________________ Street __________________________________________________________________ City____________________________________________________________________ State/Province ________________________________ Postal Code ________________ Telephone ( ) Country _____________________________ Email _______________________________________________________________________ _______________________________________________________________________ Email __________________________________________________________________

In The United States

Family_______________________________First _______________________________ Street __________________________________________________________________ City____________________________________________________________________ State ________________________________________ Postal Code ________________

Email _______________________________________________________________________ _______________________________________________________________________ Email______________________________________________________________________ Relationship __________________________________________________Relationship

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29. COURSE INTEREST: The FLTA Program is a non-degree program. You will be expected to take/attend 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? Please note: the courses you indicate are not guaranteed should you be selected for the FLTA Program.
Note: Maximum of 550 words

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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. Note: Maximum of 550 words

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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? Note: Maximum of 550 words

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Biographic Information Sheet Firs Name: Date of Birth (e.g. February 10, 2012): Postal Address: Permanent Address: Permanent City: Province: Phone #: Middle Name: Gender: Last Name:

Mobil #:

Email ID:

Pakistani National (Yes/No):

Academic Information Proposed Field of Study: Current Enrollment: Start Date: (mm/yyyy) End Date: (mm/yyyy)

Current Field of Study: Current Degree CGPA/ %age:

Current Institution:

Last Enrollment: Last Field of Study: Last Degree CGPA/ %age: Work Information Current Position: Total Years of Work Experience:

Start Date: (mm/yyyy) Last Institution:

End Date: (mm/yyyy)

Current Employer:

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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 ___________________________________ Name of Referee __________________________________________________________________________________ 1. 2. How long have you known the applicant? In what capacity have you known the applicant? Teacher or Professor School Counselor 3. Employer or Job Supervisor Other (please specify) ____________

Please provide a candid evaluation of the applicants 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)

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4. In the rating chart below please evaluate the applicant in comparison with other students whom you have known during your professional career. Excellent Creative Motivation Self-confidence Independence, initiative Intellectual ability Academic achievement Disciplined work habits Adaptability to New Situations Leadership Qualities Potential for growth Very Good Average Below Average

5.Please indicate where the applicant would rank among students/employees currently or recently in your department/organization.

95% 90%

75% TOP

50%

25% BOTTOM

____________________________________________________________________________________________ ______ Name and Title (print) ____________________________________________________________________________________________ ______ School, Company or Organization ____________________________________________________________________________________________ ______ Signature ________________________________________ ________________________________ Date

Please return directly to the Selection Committee in the applicants home country. Under no circumstances should the completed form be returned to the applicant.

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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 ___________________________________ Name of Referee __________________________________________________________________________________ 1. 2. How long have you known the applicant? In what capacity have you known the applicant? Teacher or Professor School Counselor 3. Employer or Job Supervisor Other (please specify) ____________

Please provide a candid evaluation of the applicants 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)

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4. In the rating chart below please evaluate the applicant in comparison with other students whom you have known during your professional career. Excellent Creative Motivation Self-confidence Independence, initiative Intellectual ability Academic achievement Disciplined work habits Adaptability to New Situations Leadership Qualities Potential for growth Very Good Average Below Average

5.Please indicate where the applicant would rank among students/employees currently or recently in your department/organization.

95% 90%

75% TOP

50%

25% BOTTOM

____________________________________________________________________________________________ ______ Name and Title (print) ____________________________________________________________________________________________ ______ School, Company or Organization ____________________________________________________________________________________________ ______ Signature ________________________________________ ________________________________ Date

Please return directly to the Selection Committee in the applicants home country. Under no circumstances should the completed form be returned to the applicant.

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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 ___________________________________ Name of Referee __________________________________________________________________________________ 1. 2. How long have you known the applicant? In what capacity have you known the applicant? Teacher or Professor School Counselor 3. Employer or Job Supervisor Other (please specify) ____________

Please provide a candid evaluation of the applicants 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

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known during your professional career. Excellent Creative Motivation Self-confidence Independence, initiative Intellectual ability Academic achievement Disciplined work habits Adaptability to New Situations Leadership Qualities Potential for growth Very Good Average Below Average

5.Please indicate where the applicant would rank among students/employees currently or recently in your department/organization.

95% 90%

75% TOP

50%

25% BOTTOM

____________________________________________________________________________________________ ______ Name and Title (print) ____________________________________________________________________________________________ ______ School, Company or Organization ____________________________________________________________________________________________ ______ Signature ________________________________________ ________________________________ Date

Please return directly to the Selection Committee in the applicants home country. Under no circumstances should the completed form be returned to the applicant.

Long Essays: Should not exceed two typed pages.

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Objectives: Item 15 is one of two long essays you must complete for your application. Completing the Objectives essay provides the readers (your home country contact, FLTA Program staff and your future supervisor and other university/college officials) with a picture of you and your career interests. This essay will allow you to: Emphasize key qualifications, areas of expertise, skills and/or goals Tip: Reflect on your overall qualifications and career goals: In what ways do they fit with the FLTA Program? Help the readers find out about your character/personality Tip: Think about making a good first impression Appeal to college/university supervisor expectations Tip: Consider: What qualifications are most desired by college and university professors in a language teacher/assistant? What other personal qualities do you possess that would make you attractive to them? Think about what role--or roles you expect to have on campus?

A good essay for this task will answer these questions: 1. Why are you applying for the FLTA Program? 2. What are your main qualifications? 3. What are your career goals? Item 32 Personal Statement: You should not copy your Objectives statement to this section. You should create a new essay. You may include your curriculum vitae or resume. This essay will allow you to: Tell a story Tip: Consider: Whats special, unique, distinctive and impressive about your life story? Present your life experience Tip: Consider: Why might you be a better and more successful FLTA than others? Help your future supervisor get to know you as a person Tip: Consider: What personal characteristics do you possess?