CONFIDENTIAL
Please return this form directly to the Fulbright Commission.
UNDER NO CIRCUMSTANCES SHOULD THE COMPLETED FORM BE RETURNED TO THE APPLICANT
FULBRIGHT COMMISSION
Oranienburger Str. 13-14, 10178 Berlin
FULBRIGHT American Studies Institute 2012
Certificate of Proficiency in English
(to be submitted to the Fulbright Commission)
(To be filled in by the director of courses in English, of a United States cultural institute, a professor or teacher of English, a diplomatic or
consular official of the United States, or a delegated representative of one of these persons. Ratings should be given with the following in
mind: the ability of the applicant to profit by class instruction in an American institution of higher education)
This will certify that _____________________________________________________ of
(name of applicant)
____________________, _________________ has taken an examination on his/her knowledge of English.
(town or city) (country)
with the following results: Ratings
Excellent Good Fair
Ability to understand spoken English:
Ability to comprehend the printed page
in English and to translate: (Give name of book used)
_____________________
Ability to speak English (conversation):
Ability in original written composition:
Remarks:
Signature Date
Name and Position/Title
Address
Seal of the University/ Institution (stamp):