Application Form. Study in the United States Student Leader Program

Study in the United States Student Leader Program

Application Form

Personal Information:

1.

Family Name

First Name

Patronymic

(NOTE: AS IT APPEARS IN HIS/HER PASSPORT.)

2.

3.

4.

Date of Birth (MM/DD/YYYY)

City of Birth

Country of Birth

5.

6.

Country of Residence

Country(ies) of Citizenship

7.

Home Address

City

Cell Phone

E-mail

8.

Emergency Contact Name and Relationship (Example: John Doe, Father)

Cell Phone

E-mail

9.

Male

Female

10.

Medical, Physical, Dietary or other Personal Considerations (This will not affect candidate selection, but will enable the host institution to make any necessary accommodations):

Academic Major, Institution:

11.

Major (специальность по окончании вуза)

12.

Institution (название вуза и факультет)

13.

Year in School (на каком Вы курсе в вузе)

14.

Work and Volunteer Experience:

15.

Memberships in Associations, Clubs, etc:

Please include dates (Example: Student Government, May 2011 to June 2012)

16. Please list any awards and certificates of achievements that demonstrate your leadership qualities, academic excellence and community activism. Be prepared to send us scanned copies of these awards, in case we need them (please do not send them now!)

17.

U.S. Travel:

Yes No

Purpose

Date

Yes No

18.

Family Residing in the United States: Please list any immediate family members who are currently residing in the United States, including city and state:

Yes No

19.

English Proficiency:

Reading:

Excellent

Good

Fair

Writing:

Excellent

Good

Fair

Speaking:

Excellent

Good

Fair

20. Personal Statement:

Tell us about yourself and your goals including the following: What about your background and/or interests makes you competitive for this particular institute (please be as specific as possible)? What will you contribute to the group? How do you expect this experience will affect your future academic and professional career? How will it affect you personally? Please structure your essay in paragraphs and limit your response to approximately 250 words.

21. Please attach a scanned copy of your grades for the last two semesters (for second and third-year students), or a scanned copy of your school- leaving certificate (for first-year students).

/Для студентов 2 и 3 курсов: просим приложить к заявке отсканированную копию зачетки за последние ДВА семестра. Для первокурсников: просим приложить отсканированную копию Аттестата о среднем образовании.

22. Please attach at least one recommendation from a university professor. We would like to know why you are the best candidate for the program. The recommendation can be in Russian. / Просим приложить рекомендацию от преподавателя вуза. Мы хотели бы знать, почему Вы являетесь самым достойным кандидатом на программу. Рекомендация может быть на русском языке.

IMPORTANT: Applications without personal statements, grades and reference letters will not be considered. Просим всех заявителей учесть, что анкеты без эссе, документов об успеваемости в вузе и рекомендации от преподавателя вуза рассматриваться не будут.

Completed applications may be sent by e-mail: [e-mail]

Application deadline: November 30, 2014

Please phone [phone] or e-mail [e-mail] if you have any questions.

Дата добавления: 2015-07-26