2011 Study in the United States Summer Institute
Indicate Institute (Please indicate ONLY ONE Institute, otherwise your application will not be considered):
U.S. Culture and Society
American Politics and Political Thought
Contemporary American Literature
U.S. Foreign Policy: Foundations and Formulation
Journalism and Media
Religious Pluralism in the United States
Study of the United States Institutes for Secondary School Educators
Family Name First Name Patronymic Title (Dr./Mr./Mrs./Prof.)
(NOTE: AS IT APPEARS IN HIS/HER PASSPORT.)
2. 3. 4.
Date of Birth City of Birth Country of Birth
Country of Residence Country(ies) of Citizenship
Cell phone Home Telephone E-mail
(NOTE: Please include the telephone code for your city or region.)
8. Male Female
9. Medical, Physical, Dietary or other Personal Considerations:
Current Position and Title Department
12. Work experience, most recent first:
Institution/Employer Position Dates of Employment
13. Education, Academic and Professional Training, most recent first:
Degrees/Fields of Specialization Institution Date
14. Active professional memberships:
15. Short List of Relevant Publications (maximum 10 publications): Publications should include the
publication year, type of publication, title, and publisher. All foreign titles should be translated into
English. To identify the publication type, please choose from among the following options: 1) book;
2) edited volume (as primary or co-editor); 3) book chapter; 4) journal article; 5) newspaper/online
article; 6) conference/university/government working paper.
16. U.S. Travel:
Purpose Date USG-funded
17. Family Residing in the United States: Please list any immediate family members who are currently
residing in the United States, including city and state:
18. English Proficiency:
Reading: Excellent Good Fair
Writing: Excellent Good Fair
Speaking Excellent Good Fair
19. Professional responsibilities:
Current Courses taught – Should include the course title, level of students (Ph.D., M.A.,
Undergraduate, High School), and the number of advising hours.
Current Student Advising – Should include the number of students advised who are studying
U.S. related topics, level of students (Ph.D., M.A., Undergraduate, High School), and the number of
Other Potential Outcomes – Please select all of the likely potential outcomes that might result
from your participation in this institute: 1) Update Existing Course; 2) Create New Course;
3) Create New Degree Program; 4) University Curriculum Redesign; 5) National Curriculum Redesign;
6) New Research Project; 7) New Publication; 8) Professional Promotion; 9) Government or Ministry
Policy; 10) New Professional Organization; 11) New Institutional Linkages; 12) Raise Institutional
Profile. Please explain each point marked.
20. Personal Essays, limit 4,500 characters each. 1) Please discuss your professional responsibilities
in greater detail, including how attending this Institute would help you achieve the "Other
Potential Outcomes" you have checked above; AND 2) Please discuss how your participation
would enhance this Institute, based either upon your personal and professional experience or upon
the current state of U.S. studies in your home country.
Applications without essays will not be considered.
Completed applications may be sent by e-mail: USGExchanges@gmail.com
Application deadline: November 1, 2011
Please phone (495) 728-52-42 if you have any questions.