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APPLICATION FOR THE

 

2009

GLOBAL UNDERGRADUATE EXCHANGE PROGRAM

(GLOBAL UGRAD)

 

APPLICATION DEADLINE:

November 10, 2008

 

 

Please submit your applications and

supporting documentation to the

U.S. Embassy at:

 

American Center for Educational Exchange

Jing Guang Center , Suite 2801

Hujialou, Chaoyang District, Beijing , 100020, P.R.C.,

ATTN: Peter Fasnacht

 

美国教育交流中心

中国北京朝阳区呼家楼京广中心 2801 室 邮编 100020

致 : 方秉德

 

Email: ACEEBeijing@gmail.com

 

 

 

 

A program of the

Bureau of Educational and Cultural Affairs

U.S. Department of State

 

 

Please provide all answers in English. Please use a paper/binder clip to hold application materials together. Do not staple.

 

 

NAME

Please print your name clearly exactly as it appears on your passport.

Last First Middle

 

Please indicate any other spelling(s) or name(s) you use:

 

_____________________________________________

 

 

HOME COUNTRY CONTACT INFORMATION

 

Permanent mailing address in your home country:

 

 

 

___________________________________________

 

Home telephone: ___________________________________ Mobile telephone:

 

Fax number: ______________________________________ E-mail address:_____________________________________________

 

 

PERSONAL DATA AND PASSPORT MATERIALS

 

Sex: Male Female Date of Birth: Place:

Month/Day/Year City Country

 

 

Country of permanent legal residence: __________________________ Country of citizenship:

 

 

Please provide a clear photocopy of the photo/data info page of your current Passport.

 

 

EMERGENCY CONTACT INFORMATION

Please provide the names and contact information of individuals who should be notified in case of an emergency.

 

In the United States :

Name Relationship to you Street Address

 

City State ZIP Code Telephone Number E-mail address

 

In your home country:

Name Relationship to you Street Address

 

City State and/or Country Telephone Number E-mail address

 

 

Please affix two photocopies of a Passport-size (2 x 2 inches) photograph here. Please use photocopies, not original pictures.

 

 

NAME (Please print your name here):

 

 

FIELD OF STUDY

 

Academic Major:

 

 

Other Fields of Academic Interests:

 

If you are currently enrolled as a university student, name your university:

 

How many full academic years of university study you have completed (please check one below):

 

1 year 2 years 3 years Other ______________________________________

 

Your academic calendar (e.g. March 2008 – December 2008, August 2008 – May 2009)?______________________________________

 

 

 

REFERENCES/RECOMMENDATION LETTERS

Please identify the three (3) individuals who will be writing letters of recommendation on your behalf. At least one should be from your current institution. Make sure these are people who know your academic and personal qualities well.

 

 

 

1. Name: Title:

 

 

 

Mailing address:

 

Telephone number: E-mail address:

 

 

 

2. Name: Title:

 

 

 

Mailing address:

 

Telephone number: E-mail address:

 

 

 

3. Name: Title:

 

 

 

 

 

 

Telephone number: E-mail address:

 

 

 

 

 

 

 

 

NAME (Please print your name here):

 

 

PREVIOUS ACADEMIC SCHOLARSHIPS

Please indicate any scholarships, academic awards or honors that you have received and the year received:

 

 

 

 

EDUCATIONAL BACKGROUND

Please provide complete information about all the educational institutions that you have attended and, if applicable, information about the institution(s) at which you are presently enrolled. You must attach official transcripts for undergraduate study and official results of the general secondary school leaving exam.

 

* Please identify the name of your degree by the word used at the institution that awarded you the degree. Do not provide the name of the U.S. educational system's equivalent. If you have not yet received the degree, please indicate the date (month and year) you expect to receive it.

** Please indicate your Grade Point Average (GPA) according to the system used at the institution at which you studied. Do not convert your GPA to the U.S. educational system's equivalent.

 

Please explain any gaps in your education:

 

 

 

 

 

 

 

NAME (Please print your name here):

 

 

LANGUAGE PROFICIENCY

 

Native language(s):

 

Number of years of English study: _____________________ Where studied:

 

Knowledge of foreign languages, including English (Rate your abilities as Excellent, Good, or Fair):

 

 

 

STANDARDIZED ENGLISH TEST SCORES

 

If you have a TOEFL? or ITP score, please report it below.

 

 

 

NON-ACADEMIC ACTIVITIES

Please list other community service, internships/jobs, sports or cultural activities in which you have participated regularly in the past two years. If you were a team leader, council member or other officer in any institution or activity, please note that as well.

 

 

 

 

 

NAME (Please print your name here):

 

 

Physical Challenges/Disabilities

Please describe any physical disabilities you might have. If you require any special equipment or medical treatment as a result of the physical disabilities, please describe it. This information is gathered for statistical purposes and to ensure appropriate placement. The Global UGRAD Program does not discriminate on the basis of race, color, religion, sex, national origin, and/or physical disabilities.

 

 

 

 

 

Family Background

Please complete the following regarding your family:

 

Father's Name:

 

Occupation:

 

Highest level of education attained:

 

None Number of primary school years_____ Number of secondary school years_____

 

Secondary Diploma Bachelor Degree Master Degree Ph.D.

 

Father's Employment: Employed Retired ___________Year Deceased ___________ Year

 

 

Mother's Name:

 

Occupation:

 

Highest level of education attained:

 

None Number of primary school years_____ Number of secondary school years_____

 

Secondary Diploma Bachelor Degree Master Degree Ph.D.

 

Mother's Employment: Employed Retired ___________Year Deceased ___________ Year

 

 

Number of siblings in your immediate family: Number of Brothers: Number of Sisters:

 

 

HOW did you find out about the Global UGRAD Program? Please check all that apply.

 

The American Embassy Advising Office or other Embassy contact The Fulbright Commission

 

From a friend From a relative From a teacher or professor

 

From an advertisement or notice (Please specify the location) :

 

Other (Please specify how) :

 

 

 

 

ESSAY: Personal Statement—350 – 500 words, typed.

 

If you are completing a computer application, please insert your essay responses below the appropriate essay question. If you are completing a paper application, please type your essay responses on separate sheets of paper and attach them to your completed application. Please describe yourself and write a clear and detailed description of your academic objectives and the reasons why you wish to pursue them in the USA . Discuss your goals both in terms of your field of study and your own personal development. Describe the type of program you wish to pursue in the USA and how it relates to your academic background and interests and your objectives for the future. The essay is an essential part of the selection process and of your application for placement into an appropriate program. Be sure to include any details that highlight your personality and individuality.

 

 

GRANT SUSPENSION/TERMINATION/REVOCATION

 

A grant may be revoked, terminated, or suspended.

 

Grounds for revocation or termination include, but are not limited to: (1) violation of any law of the United States or the host country; (2) any act likely to give offense to the host country; (3) failure to observe satisfactory academic or professional standards; (4) physical or mental incapacitation; (5) engaging in any unauthorized income-producing activity; (6) failure to comply with the grant's terms and conditions; (7) material misrepresentation made by any grantee in the application form or grant document.

 

A grant may be suspended if: (1) the grantee ceases to carry out the project or academic program during the grant period; (2) the grantee leaves the host country without authorization of the Commission/post or supervising agency; (3) conditions in the host country require the departure of the grantee for reasons of personal safety or security.

 

SIGNATURE

 

By my signature, I certify that, to the best of my knowledge, the information provided in my application is accurate and complete, and that I intend to return to my home country upon completion of my studies in the United States. I also authorize any school or university which I have attended or will attend to release my transcripts and any report to the designated placement agency.

 

 

 

Signature: Date:______________________________________

 

 

 

CHECKLIST FOR COMPLETE APPLICATION DOSSIER:

Before submitting your application to the address on the front page, please be sure you have included all of the following REQUIRED components:

 

___Completed, signed Global Undergraduate Exchange Program application form.

___Personal statement in English, 350-500 words, typed.*

___Copy of the data/photo pages of your passport.

___Official transcripts for years of university study (with English translations). Please provide grade equivalences to U.S. University

grading system.*

___Official results of the national general secondary school leaving exam.*

___Three letters of recommendation from teachers/professors, including one from the candidate's secondary level institution (with

English translations).*

___TOEFL a or ITP a score report, minimum 500, 520 or higher preferred.

___Two photocopies of passport-size photo.

 

 

*All documents should be submitted in plain, letter-sized (8 ? x 11 inch) paper.