2011-2012 Global Undergraduate Exchange Program in Eurasia & Central Asia Application Number
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2011-2012 Global Undergraduate Exchange Program in Eurasia & Central Asia Application Number ____________ (for IREX use only) Name: ______________________________________ Country of Citizenship: _________________________________ Date of Birth: ______________________________________ 2011-2012 GLOBAL UndergraduateExchange Program IN EURASia & central asiaSupplemental FormA program of the Bureau of Educational and Cultural Affairs of the United States Department of State and implemented by IREX 1. How did you first learn about the Global Undergraduate Exchange Program? Please check only one. Academic Advisor American Corner Conference Booth Educational Advising Center Electronic listserv Friend/Colleague Fulbright Commission IATP site Internet IREX Lecture/Presentation Newspaper/Advertisement Program Alumni Radio Television University faculty/staff U.S. Embassy Other: (please specify) ^ Yes No If yes, please specify program: Name of sponsoring organization: _______________ 3. What is the approximate population of the city listed in your permanent home address (Question #10 on the application)? ______________________________ ^ Please attach a personal statement in English of no more than 1000 words addressing the following questions. Note: Your personal statement must be your own work. Plagiarism (using someone else’s words and claiming them as your own) will not be tolerated. If your personal statement is found to be plagiarized, your application will be disqualified. Additional pages can be found at the very end of this supplemental form. Statement A: Please describe why you would like to study in the US. What past experiences have given you this motivation? How will studying on the Global UGRAD program help you learn about America? How will learning about the U.S. influence your personal and professional goals for the future? ^ Please attach a personal statement in English of no more than 1000 words addressing the following questions. Note: Your personal statement must be your own work. Plagiarism (using someone else’s words and claiming them as your own) will not be tolerated. If your personal statement is found to be plagiarized, your application will be disqualified. Additional pages can be found at the very end of this supplemental form. Statement B: Please describe your idea of good leadership. Who do you think is a good leader, and why? What is one of his/her leadership traits that you admire? Please provide an example of when you have been a leader. How have you utilized your leadership skills in handling any difficult interactions with someone from another culture or background? ^ Please attach a personal statement in English of no more than 1000 words addressing the following questions. Note: Your personal statement must be your own work. Plagiarism (using someone else’s words and claiming them as your own) will not be tolerated. If your personal statement is found to be plagiarized, your application will be disqualified. Additional pages can be found at the very end of this supplemental form. Statement C: Please write a letter of introduction to your future American roommate or host family. Please describe yourself. What are your likes and dislikes, hobbies, and interests? What activities and organizations do you hope to participate in while in the US? What are your family and home community like? What accomplishment of yours are you most proud of? IREX Privacy Policy Statement and Application CertificationYour privacy is important to IREX. That is why we request that all applicants read the following privacy policy statement carefully.
Information about program applicants and current and past participants consists of data contained in their applications, information derived from interviews, and information gathered during the course of their program and as program alumni. IREX stores this information in written and electronic form indefinitely. Some data, such as contact information and professional experience, is continually updated. ^ Information, which is described above, may be: A. Used by selection committees and interviewers to review applicants; B. Supplied to the program’s funding organization; C. Submitted to potential host schools, universities, or organizations and/or organizations that provide internship opportunities; D. Used for the evaluation of an individual’s participation in the program and in the collection of data for general program evaluation by IREX, funding agencies or other organizations contracted to conduct evaluations; E. Used for notifying program participants/alumni of upcoming events and programs; F. Provided to participants/alumni of this and other US government–sponsored programs for the purpose of fostering alumni networking; G. Provided to non-commercial, nongovernmental organizations for the purposes of promoting professional development among program participants/alumni; and H. Used by IREX for general promotional purposes in written or electronic form, including program directories, newsletters, web sites and other promotional materials. If the applicant or current/past participant does not want to be included in points E-H, it is their responsibility to notify their specific program administrator at IREX/Washington. IREX does not sell applicant, or current/past participant information. The principles stated herein are binding only to IREX; other organizations involved in the administration of these programs may adhere to other privacy or similar policies. I certify that I completed this application myself, without assistance, that the information given in this application is complete and accurate and that I further certify that I fulfill all of the eligibility requirements as stated in the application instructions. I have carefully read and understand all notes and disclaimers provided therein. I understand that IREX reserves the right to verify all the information listed in the application. I understand that giving false or misleading information in the application will result in exclusion from the competition or immediate dismissal from the Global Undergraduate Exchange Program. Signature of applicant Date ^ (TO BE COMPLETED BY APPLICANT): Name of Applicant Country Name of Evaluator/Reference Title of Evaluator Work Institution Work Address of Evaluator Work Telephone of Evaluator Fax E-mail This reference form may be completed by a supervisor at work, a professor/academic advisor/dean, or a community leader who knows the applicant well and is familiar with the applicant’s academic and/or professional work. Relatives and friends of the applicant may not complete this recommendation form. This form should be typewritten in English, if possible. If not in English, an accurate translation (which may be done by the applicant) must be attached. All recommendations must be signed at the bottom, but DO NOT require a stamp. Please return the completed reference form to the applicant to be submitted with the completed application. Please DO NOT send reference forms directly to IREX. Reference Form #1 and Reference Form #2 must be completed by two different individuals. ^ 1 How long have you known the applicant? 2 In what capacity have you known the applicant? Check all that apply. Teacher/Professor Job Supervisor Academic Advisor Other (please specify) 3 Please evaluate the applicant as compared to other students in terms of the characteristics below: Excellent Good Fair Poor Unable to Judge
4 Please choose one of the following: Recommend with confidence Recommend with reservation Do not recommend ^ EVALUATION Please submit short statements in the space provided, giving a candid evaluation of the applicant’s past academic and/or work performance. Your statements will be given careful consideration by the selection panel reviewing this application. Therefore, your comments should be as complete and detailed as possible (attach additional pages if necessary). ^ 2. Applicant’s ability to interact well with other students and professors. 3. Applicant’s strengths and weaknesses as a potential exchange student. 4. Applicant’s outstanding or distinguishing talents and characteristics. ^ I hereby confirm that the answers on this form are my own and represent my professional opinion of the applicant. Signature of Evaluator Date ^ (TO BE COMPLETED BY APPLICANT): Name of Applicant Country Name of Evaluator/Reference Title of Evaluator Work Institution Work Address of Evaluator Work Telephone of Evaluator Fax E-mail This reference form may be completed by a supervisor at work, a professor/academic advisor/dean, or a community leader who knows the applicant well and is familiar with the applicant’s academic and/or professional work. Relatives and friends of the applicant may not complete this recommendation form. This form should be typewritten in English, if possible. If not in English, an accurate translation (which may be done by the applicant) must be attached. All recommendations must be signed at the bottom, but DO NOT require a stamp. Please return the completed reference form to the applicant to be submitted with the completed application. Please DO NOT send reference forms directly to IREX. Reference Form #1 and Reference Form #2 must be completed by two different individuals. ^ 1 How long have you known the applicant? 2 In what capacity have you known the applicant? Check all that apply. Teacher/Professor Job Supervisor Academic Advisor Other (please specify) 3 Please evaluate the applicant as compared to other students in terms of the characteristics below: Excellent Good Fair Poor Unable to Judge
4 Please choose one of the following: Recommend with confidence Recommend with reservation Do not recommend ^ EVALUATION Please submit short statements in the space provided, giving a candid evaluation of the applicant’s past academic and/or work performance. Your statements will be given careful consideration by the selection panel reviewing this application. Therefore, your comments should be as complete and detailed as possible (attach additional pages if necessary). ^ 2. Applicant’s ability to interact well with other students and professors. 3. Applicant’s strengths and weaknesses as a potential exchange student. 4. Applicant’s outstanding or distinguishing talents and characteristics. ^ I hereby confirm that the answers on this form are my own and represent my professional opinion of the applicant. Signature of Evaluator Date ^
Applications are free of charge and may be duplicated Deadline: 5:00 PM, Friday, January 14, 2011 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
