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American Council of Learned Soci

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									                          CENTER FOR EDUCATIONAL EXCHANGE WITH VIETNAM
                             a subsidiary of the American Council of Learned Societies
                                So 5, Ngo 52, Pho Giang Van Minh, Ba Dinh, Hanoi, Vietnam
                                 Tel: 4-3723-6825 / Fax: 4-3723-6827 / E-mail: edex@ceevn.org




        APPLICATION FOR REGIONAL LANGUAGE STUDY FELLOWSHIP
                                           2008 - 2010
This application is formatted to be typed by computer and must be submitted in the original
format.

Select one (1) language below:
Hmong           Thai         Khmer                Lao           Indonesian                 Burmese

Name:
                                                                                  Male      Female
(As it appears in Vietnamese)                                                     (circle one)

Date of Birth (Day/Month/Year):        /     /           Place of Birth:
Present position:


Field(s) of Specialization:

Department:
Institution name, with address:


Institution
Telephone (office):                        Fax:
Home address:

Home
Telephone (home):                          E-mail:

1. Professional Background
   Positions held (teaching, research, administrative), beginning with most recent.

   Name of Institution                Position                             Period of Employment
                                                                           (month/year - month/year)
                                                                              /        -    /

                                                                              /        -    /

                                                                              /        -    /

                                                                              /        -    /




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2. Current Responsibilities: Please describe your work responsibilities in your current
   position, especially with regard to teaching and/or research. This section is formatted to
   allow you to type as many lines as needed.




3. Language Study History

Name of Institution                    Language                      Period of Enrollment
                                                                    (month/year – month/year)
                                                                        /      -       /

                                                                        /      -       /

                                                                        /      -       /


4. Personal Statement of Career Objectives:

In 1,000 words, please describe your past and present interest in the language you propose to
study. What experiences and interests have influenced you to coninue studying this language?
What are your professional and career goals? Discuss how learning this language will help you
achieve these goals.

8. Emergency Contact: Please provide the name and relationship of the person to be notified in
the case of emergency:
Name:                                              Relationship:
Address:

Telephone:                                     Email:

9. Signature:
I hereby certify that the information provided in this application is complete and accurate. If
awarded a fellowship, I agree to comply with any necessary regulations and return to my home
country upon expiration of my study program abroad.

Signature of Applicant:                                               Date:




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COMPLETED APPLICATION CHECKLIST

Submit the completed Application to the CEEVN-Hanoi office (address at the beginning of this
application)

CEEVN will not be able to process applications that are missing required documents.

Required for all applications:

   Completed & Signed Application Form

   Personal Statement, 1000 words

   Notarized copies of official university transcripts. Copies must be notarized. If the original
   documents were in Vietnamese, an English translation of each document must also be
   notarized.

   Nomination Letter from Applicant’s Institution




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