OAS USTTI IMT Scholarship Application Form

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OAS USTTI IMT Scholarship Application Form Powered By Docstoc
					                             OAS–USTTI PROFESSIONAL DEVELOPMENT SCHOLARSHIPS
                                                UNDER THE
                        OAS PARTNERSHIPS PROGRAM FOR EDUCATION AND TRAINING - PPET

                                              “IMT (3G/4G) Mobile Broadband and Mobile TV”

                                                 Scholarship Application Form:

Applicants should complete and submit the Scholarship Application Form and the required documents in
English, preferably in PDF format, no later than September 21st, 2012, via e-mail to pdsp@oas.org, with copy
to afarfan@oas.rg and lzeayonker@oas.org with the subject matter: “OAS-USTTI Scholarships IMT (3G/4G)”

     I.          PERSONAL INFORMATION

Full name as it appears on your passport. Please use capital letters for your last name.


      Last name                                     First name                                  Middle name
------------------------------------------------------------------------------------------------------------------------------------------
Date of Birth                                                   Sex:

     /     /
(Day/month/year)                                                  Male                       Female

------------------------------------------------------------------------------------------------------------------------------------------
Place of Birth


          City                                           State or province                                 Country
------------------------------------------------------------------------------------------------------------------------------------------
 Country of citizenship/residency                                                      Nationality


------------------------------------------------------------------------------------------------------------------------------------------
 Current Address


           Street                                                            Apt. number or P.O. Box


          City                          State or province                 Postal code                        Country

                                                                                                                                             1
     ------------------------------------------------------------------------------------------------------------------------------------------
     Telephone (with area code)                                                 Email:


                     Home                                                                  Office
     ------------------------------------------------------------------------------------------------------------------------------------------
     Emergency Contact Information:

     Name:


         Last name                                  First name                                       Middle name

     Telephone (with area code)                                             Email:


            Home                                                                    Office
     ------------------------------------------------------------------------------------------------------------------------------------------
     Have you ever been awarded an OAS academic scholarship?
                            No         Yes

     If the answer is yes, please indicate the date:

                           /        /
                  (day/month/year)
     ------------------------------------------------------------------------------------------------------------------------------------------

     III. ACADEMIC AND PROFESSIONAL INFORMATION:

     POST-SECONDARY STUDIES

     Include all post-secondary schools attended, even if you did not graduate. If you have not completed
     your academic program, include the date you expect to receive your degree. All dates should include
     both month and year. Indicate your grade point average for each degree received, with the maximum
     range possible (for example “3.0 out of 4.0 or “4.1 out of 5.0” or “8.9 out of 10”). For institutions that
     indicate the class of degree conferred, please note the class of your degree (for example, Second Class
     (Upper Div.), Pass, First Class).

     If you are currently enrolled in an academic program, please include your current GPA.
1.
        From
                             To (mo/yr.)                   Institution and location                              Degree
       (mo/yr.)

     Graduation
                                                                    Field/
        Date                     GPA                                                                          Class Honors
                                                                 Specialization
      (mo/yr.)

2.
        From
                             To (mo/yr.)                   Institution and location                              Degree
       (mo/yr.)

                                                                                                                                                  2
     Graduation
                                                        Field/                       Class Honors
        Date                  GPA
                                                     Specialization
      (mo/yr.)

3.
          From
                          To (mo/yr.)           Institution and location                Degree
         (mo/yr.)

     Graduation
                                                        Field/                       Class Honors
        Date                  GPA
                                                     Specialization
      (mo/yr.)


     WORK EXPERIENCE
     Beginning with the most recent position, please summarize your professional experience (including
     teaching and research) by listing the name of each employer, your titles or positions, a brief description
     of your duties, and the dates you held each position. The information given here may be expanded in
     your curriculum vitae.

     Name and location                    Title or                     From              To
      of the institution         Position/Responsibilities            (mo/yr.)         (mo/yr.)




     IV. ESSAYS
     These essays are intended to evaluate the potential and commitment of the candidate to apply the
     knowledge and skills acquired during the scholarship period to the development of his/her country of
     origin and the financial need of the candidate. Each essay must contain between 300 and 800 words.

           1. Describe how acquiring this professional development training will directly impact and enhance
              your professional skills in your current job position.



           2. Please explain how you intend to apply the acquired knowledge and experience in the specific
              field of study that you will pursue to the development in your country or region.



     V. SUPPORTING DOCUMENTS
     As indicated in the scholarship announcement, please note that you are required to submit the
     following documents with this application form:
      Copy of the transcript of the latest degree obtained
      Updated resume
      One letter of recommendation of current or most recent employer
          Proof of English Proficiency, if not the native language
          Formal application through the USTTI. Applications may be filed through USTTI’s website:
           http://ustti.org
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