LAST NAME:
(Please write in ink)
2010 FELLOWSHIP FOR THE FUTURE
Application Form
1. Before completing the application form, you must carefully read the Fellowship Announcement and Notes for Applicants, available at www.haz.iro.hr. 2. Complete the application in English. Print the application from a computer, or complete clearly in black ink. Please do not staple or fasten any documents to this form. 3. Incomplete applications will not be considered. Standardized test scores can be reported after the Fellowship for the th Future application deadline, but no later than January 20 . You must send your test scores as soon as they become available. 4. Please use day/month/year format for dates. 5. Questions must be answered completely and carefully. Please make every effort to limit your responses to the space provided. Candidates can attach additional sheets only if they feel the space provided does not allow them to adequately describe a certain experience or activity. Please note: The application form may in some categories provide more space than a candidate needs. You may leave extra fields blank.
GENERAL INFORMATION
1.
LAST NAME
2.
FIRST NAME(S)
3.
NAME ON PREVIOUS ACADEMIC RECORDS (if different)
4. 7. 9.
COUNTRY OF CITIZENSHIP PLACE OF BIRTH:
5.
COUNTRY OF RESIDENCE
6.
GENDER: MALE
FEMALE
8.
DATE OF BIRTH (day/month/year)
DO YOU HAVE; OR HAVE YOU EVER HELD: U.S. CITIZENSHIP? Yes No DUAL CITIZENSHIP? Yes No U.S. PERMANENT RESIDENCY? Yes No
10.
ACADEMIC PROGRAMS FOR WHICH YOU ARE SEEKING FUNDING
In the order of preference, please list up to FOUR Master’s programs at U.S. universities to which you are applying directly for admission in the academic year 2010/2011. If you have been admitted, write “admitted” in the last column. School/program/department University and Location Degree and Duration (one or two years) Application deadline Notification by
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LAST NAME:
(Please write in ink)
11.
EDUCATION (HIGHER EDUCATION, from age 18) List all post-secondary educational institutions attended (most recent first), including any in whom you may be presently enrolled. Include all post-secondary institutions, even those from which you did not receive a degree. ACTUAL NAME OF DATES DEGREE OR DIPLOMA MAJOR FIELD OF DATE RECEIVED INSTITUTION AND LOCATION (Month/Year) STUDY (do not translate) OR OR EXPECTED From To REASON FOR VISIT
12.
OCCUPATIONAL EXPERIENCE List positions held, beginning with the most recent employment, if any. Include any paid or unpaid internships. If you need additional space to describe an experience, you may attach an additional sheet. Leave extra rows blank. DATES TITLE(S) HELD AND SHORT DESCRIPTION OF RESPONSIBILITIES AND (Month/Year) NAME AND ADDRESS OF ACCOMPLISHMENTS EMPLOYER From To
2
LAST NAME:
(Please write in ink)
13.
PROFESSIONAL/EXTRACURRICULAR ACTIVITIES List any activities you wish to highlight, such as participation in training programs, special projects, volunteering, membership in professional or student associations, or other examples of leadership and engagement. If you need additional space to describe an activity, you may attach an additional sheet. Leave extra rows blank. DATES ORGANIZATION/ACTIVITY (Month/Year) SHORT DESCRIPTION OF ACTIVITY AND YOUR ENGAGEMENT AND LOCATION From To
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LAST NAME:
(Please write in ink)
14.
SCHOLARSHIPS, FELLOWSHIPS AND/OR ACADEMIC HONORS List any scholarships or fellowships held at present or in the past. Please give source, amount, where held and duration. List any academic honors or prizes which you have received. Include titles and dates.
15.
PUBLICATIONS If applicable, list any books, articles or theses published by you, especially in your proposed field of study. Give title, place and date of publication.
16.
EXPERIENCES ABROAD If you have traveled, lived or studied in any country other than your own for more than a month, indicate places, dates and reasons (education, research, business, vacation, etc.). List only experiences you have not listed so far.
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LAST NAME:
(Please write in ink)
17.
KNOWLEDGE OF LANGUAGES Rate yourself as Excellent, Good or Fair. Include all languages in which you have some competence. MOTHER TONGUE: LANGUAGE English READING HOW MANY YEARS HAVE YOU STUDIED ENGLISH: WRITING SPEAKING
18.
STANDARDIZED TEST SCORES You are expected to take standardized tests required of you by the university or universities in the United States to which you are applying. It is your responsibility to familiarize yourself with the admissions requirements of the academic program(s) to which you are applying, and to meet these requirements. All international students are typically required to take TOEFL. If you have not yet taken a certain test required of you, please write the expected test date, and send your scores as soon as they become available. If you have taken a test multiple times, please list scores for each test date. Leave blank if a test does not apply to you. TOTAL READING LISTENING SPEAKING WRITING DATE(S) SCORE TOEFL
GRE General Exam
DATE(S)
TOTAL (score / percentile)
VERBAL (score / percentile)
QUANTITATIVE (score / percentile)
ANALYTICAL WRITING (score / percentile)
DATE(S) GMAT
TOTAL (score / percentile)
VERBAL (score / percentile)
QUANTITATIVE (score / percentile)
ANALYTICAL WRITING (score / percentile)
DATE(S) GRE Subject Exam
TEST NAME
SCORE (score / percentile)
SUBSCORE NAME
SCORE (score / percentile)
DATE (S) LSAT
SCORE
SCORE BAND
PERCENTILE
DATE(S) OTHER
TEST
SCORE
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LAST NAME:
(Please write in ink)
19.
PERSONAL STATEMENT Using no more than 1,000 words, write a narrative statement which describes your academic and career background and your future goals. This response should not be a mere listing of facts, but rather a candid essay about your achievements and your career plans upon return from the desired course of study. You can include information about your education, practical experiences, special interests, and personal motivation. One of the criteria for the evaluation of candidates is the potential for leadership and impact in the candidate’s field in Croatia. The personal statement should demonstrate how you fulfill this criterion.
20.
STATEMENT OF STUDY PLANS Using up to 500 words, describe the academic program(s) you are applying to and explain why you wish to study there. Tell us more about your major field and any specialized interests within this field.
21.
REFERENCES List persons whom you have asked to write letters of reference on your behalf. Referees should know you from your academic and/or work experience. Minimum one academic reference is required. Letters of reference should be included in the application package in sealed, signed envelopes. POSITION AND RELATIONSHIP TO YOU NAME EMAIL INSTITUTION AND HOW LONG .
22.
OTHER SCHOLARSHIPS Indicate if you are planning to apply for a fellowship, scholarship, assistantship or other educational grant or loan from another organization, government or educational institution. This information will not prejudice your application. Please note: you should ask to be considered for financial aid by the university you are applying to if you have that option.
23.
ADDITIONAL INFORMATION Please include any other information not covered in this application which you consider relevant. You can include information on any special circumstances which the selection committee should be aware of.
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LAST NAME:
(Please write in ink)
24. SIGNATURE I certify that the information given in this application is complete and accurate to the best of my knowledge. I understand that I am not entitled to hold, nor do I hold, U.S. citizenship or permanent residence. I understand that, should I be short-listed for the Fellowship for the Future, final award will be dependent upon my acceptance to a U.S. institution for study, listed in this application, and upon my eligibility for a visa to the United States, in addition to my qualifications and references. Upon the completion of an authorized stay in the United States supported by the Fellowship for the Future, I plan to return to Croatia for a minimum of three (3) years.
Name:
Signature and date:
25.
APPLICATION CHECKLIST – COMPLETED APPLICATION PACKAGE
Have you included the following: APPLICATION FORM (completed and signed) UNIVERSITY TRANSCRIPT(S) ENGLISH TRANSLATION OF UNIVERSITY TRANSCRIPT(S) PROOF OF UNIVERSITY DIPLOMA(S) LETTERS OF REFERENCE (submitted in sealed, signed envelopes) OFFICIAL STANDARDIZED TEST SCORE REPORT(S) COPY OF PASSPORT PHOTO PAGE WORD FILE OF THE COMPLETED APPLICATION FORM ORIGINAL COPY ONE PHOTOCOPY ORIGINAL COPY(S) ONE PHOTOCOPY OF EACH ORIGINAL TWO PHOTOCOPIES OF EACH CERTIFIED TRANSLATION TWO PHOTOCOPIES OF EACH DIPLOMA THREE ORIGINAL COPIES ONE PHOTOCOPY OF EACH ORIGINAL TWO PHOTOCOPIES OF EACH SCORE REPORT I WILL SEND SCORES LATER TWO PHOTOCOPIES SUBMITTED ON A CD WITH YOUR NAME
The complete application package must be posted by registered mail and must reach the Croatian-American Foundation for Education and Training by December 11th, 2009 at 5 pm the latest, at the following address: Croatian-American Foundation for Education and Training Preradovićeva 33/I HR-10000 Zagreb Contact: Ana Budin, abudin@haz.iro.hr, tel. +385 1 4817195 or +385 1 4555151
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