Exchange Program APPLICATION

A program of the Bureau of Educational and Cultural Affairs,United States Department of State

1. NAME (as written on official documents):

(Family Name) (First Name) (Middle/Patronymic)

2. COUNTRY OF CITIZENSHIP:

3. COUNTRY OF LEGAL Residence:

4. PLACE OF BIRTH:

(City or Town) (Country)

5. DATE OF BIRTH:

(Month) (Day) (Year)

6. GENDER: Male: Female:

7. MARITAL STATUS:  Single  Married CITIZENSHIP OF SPOUSE (if applicable):

8. CURRENT HOME ADDRESS: Is this a dormitory address? Yes No

Street/Building Number: Apartment:

City: Postal Index:

Region or Oblast: Country:

Telephone: () Fax: () Email:

Cell phone (if applicable): _(_________)_______________________________

PERMANENT HOME ADDRESS (IF DIFFERENT):

Street/Building Number: Apartment:

City: Postal Index:

Region or Oblast: Country:

Telephone: () Fax: () Email:

Cell phone (if applicable): ()__________________________________

9. CURRENT ACADEMIC INSTITUTION:

FACULTY/DEPARTMENT:

Street:

City: Postal Index:

Country: Telephone: () Fax: ()

10. PRESENT COURSE YEAR:  First  Second Third* (*only for students enrolled in 5-year university programs)

11. EXPECTED GRADUATION DATE (month/year):

12. CURRENT SPECIALIZATION / MAJOR IN HOME COUNTRY: ____

13. PROPOSED FIELD OF STUDY IN THE US:

Please indicate one specialization below, which most closely matches your current specialization. Unless otherwise noted, all fields of study are offered for first-, second-, and third-year students. If selected as a finalist, applicants may not change their field of study during the program.

Accounting (first-year only)

Agriculture

American Studies

Business

Computer Science (first-year only)

Criminal Justice

Economics (second- and third-year only)

Education (second- and third-year only)

Environmental Management

Hospitality Management (first-year only)

International Relations (second- and third-year only)

Journalism and Mass Communications

Law (first-year only)

Political Science

Psychology (first-year only)

Sociology

Signature of applicant ______________________________________________ Date _________

III.Role play

Дата добавления: 2015-07-10