2014 Summer Institutes Application

7/27/2019 2014 Summer Institutes Application

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APPLICATION

1. NAME (as written on official documents):____________________________________________

(Family Name) (First Name) (Middle)

. !ummer Institute: En"ironmental !tewards#i$

%. CO&NT' O CITI*EN!+IP: ROMANIA

,. CO&NT' O LE-AL 'E!IENCE:

/. PLACE O 0I'T+:

(City or Town) (Country)

. ATE O 0I'T+:

(Month) (Day) (Year)

2. Male: emale:

3. C&''ENT +OME A'E!!:

treet!"uildin# Num$er: A%artment:

City: &ostal Inde':

Country:

Tele%hone: mail: _________________________________________

41, !&MME' IN!TIT&TE! O'

E&'OPEAN !T&ENT LEAE'!

A P'O-'AM O T+E 0&'EA& O E&CATIONAL AN C&LT&'AL AAI'!5

&.!. EPA'TMENT O !TATE


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Name:666666666666666666666666666666

41, !ummer Institutes for Euro$ean !tudent Leaders

Mo$ile :___________________________

7. PE'MANENT +OME A'E!!:

treet!"uildin# Num$er: A%artment:

City: &ostal Inde':

Country:

14. NAME O C&''ENT ACAEMIC IN!TIT&TION: ______

FAC*+TY!D&ARTMNT:

Address:

City: &ostal Inde':

Country: Tele%hone: ______________________

11. P'E!ENT !T& P'O-'AM: First Year e,ond Year Other__________________

1. E8PECTE -'A&ATION ATE (mont#9ear):

1%. C&''ENT !PECIALI*ATION 9 IEL of !T&: 6666

1,. +a"e ou e"er tra"eled outside of 'omania; Yes No I- yes. %lease list all ,ountries:

_______________________________________________________________________________

1/. +a"e ou e"er tra"eled to t#e &nited !tates; es NoI- you ha/e tra/eled to the *nited tates. what was the %ur%ose o- your /isit0

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1. EN-LI!+ LAN-&A-E P'OICIENC: I- you are sele,ted as a %arti,i%ant and n#lish is

not your nati/e lan#ua#e. you will $e as1ed to ta1e an n#lish lan#ua#e assessment at the start o-

the summer %ro#ram2 I- you ha/e %re/iously ta1en an o--i,ial n#lish lan#ua#e e'am. su,h as theTOF+. %lease list the name o- the e'am. your s,ore and the date and %la,e where you too1 the

e'amination2

3


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66666 !core: 66666666666666 ate: 66666666666666Location: 6666666666666

12. Please ran= our En>lis# lan>ua>e $roficienc in t#e followin> areas:

%ea1in#: Fair 4ood ',ellent

Readin#: Fair 4ood ',ellent

5ritin#: Fair 4ood ',ellent

13. Please descri?e an $re@e medical conditions or ot#er dietar and $ersonal

consideration. The in-ormation you %ro/ide will not a--e,t your sele,tion in the %ro#ram. $ut willena$le the host institution to ma1e any ne,essary a,,ommodations2_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

17. E8T'A@C&''IC&LA ACTIITIE!: &lease list all /olunteer %ositions. wor1 e'%erien,e.

awards. and leadershi% %ositions you ha/e held within the %ast -our years2

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e se%arate short essays o- no more than 788 words addressin# the -ollowin# 9uestions2

A. 5hy are you interested in %arti,i%atin# in this %ro#ram0 5hat do you ho%e to learn0

0. *sin# one or more e'am%les. %lease des,ri$e a ,hallen#e at s,hool. wor1. or in your %ersonal

li-e that you ha/e had to o/er,ome2 ow did you resol/e the situation0

C. &arti,i%ants in the ummer Institutes use their summer e'%erien,es to #i/e $a,1 to their

,ommunities2 In what ways ,an you ima#ine #i/in# $a,1 to your ,ommunity a-ter you

%arti,i%ate in the ummer Institute0

1. ATA INB&I': ow did you hear a$out this %ro#ram0

Ful$ri#ht Commission Friend Other: _________________

PLEA!E 'EMEM0E' TO !&0MIT O&' APPLICATION5 E!!A!5 T'AN!C'IPT!5

AN 'EE'ENCE! 0 Marc# 15 41, .

;


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!ummer Institutes for Euro$ean !tudent LeadersA $ro>ram of t#e 0ureau of Educational and Cultural Affairs5

&.!. e$artment of !tate

'EE'ENCE O'M

(TO 0E COMPLETE 0 APPLICANT):

Name o- A%%li,ant__________________________________________________________________

Country___________________________________________________________________________

Name o- /aluator!Re-eren,e__________________________________________________________

Title o- /aluator___________________________________________________________________

5or1 Institution____________________________________________________________________

5or1 Address o- /aluator___________________________________________________________

5or1 Tele%hone o- /aluator Fa'____________ o$ u%er/isor A,ademi, Ad/isor

Other (%lease s%e,i-y)

% &lease e/aluate the a%%li,ant as ,om%ared to other students in terms o- the ,hara,teristi,s $elow:

',ellent 4ood Fair &oor *na$le to >ud#e

+eadershi% &otential

Cross


6/10



'EE'ENCE O'M

Maturity

, &lease ,hoose one o- the -ollowin#:

?Re,ommend with ,on-iden,e

?Re,ommend with reser/ation

?Do not re,ommend

/? EAL&ATION

&lease su$mit short statements in the s%a,e %ro/ided. #i/in# a ,andid e/aluation o- the a%%li,ant=s %asta,ademi, and!or wor1 %er-orman,e2 Your statements will $e #i/en ,are-ul ,onsideration $y the sele,tion

%anel re/iewin# this a%%li,ation2 There-ore. your ,omments should $e as ,om%lete and detailed as

%ossi$le (atta,h additional %a#es i- ne,essary)2

1. A$$licants a?ilit to e and "er?all.

. A$$licants a?ilit to interact well wit# ot#er students and $rofessors.

%. A$$licants stren>t#s and wea=nesses as a $otential ee student.


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'EE'ENCE O'M

,. A$$licants outstandin> or distin>uis#in> talents and c#aracteristics.

/. A$$licants $otential to si>nificantl contri?ute to t#e $u?lic sector in #is9#er #ome communit.

I here$y ,on-irm that the answers on this -orm are my own and re%resent my %ro-essional o%inion o- the

a%%li,ant2

i#nature o- /aluator Date


8/10



'EE'ENCE O'M

(TO 0E COMPLETE 0 APPLICANT):

Name o- A%%li,ant__________________________________________________________________

Country___________________________________________________________________________

Name o- /aluator!Re-eren,e__________________________________________________________

Title o- /aluator___________________________________________________________________

5or1 Institution____________________________________________________________________

5or1 Address o- /aluator___________________________________________________________

5or1 Tele%hone o- /aluator Fa'____________ o$ u%er/isor A,ademi, Ad/isor

Other (%lease s%e,i-y)

% &lease e/aluate the a%%li,ant as ,om%ared to other students in terms o- the ,hara,teristi,s $elow:

',ellent 4ood Fair &oor *na$le to >ud#e

+eadershi% &otential

Cross


9/10



'EE'ENCE O'M

Maturity

, &lease ,hoose one o- the -ollowin#:

?Re,ommend with ,on-iden,e

?Re,ommend with reser/ation

?Do not re,ommend

/? EAL&ATION

&lease su$mit short statements in the s%a,e %ro/ided. #i/in# a ,andid e/aluation o- the a%%li,ant=s %asta,ademi, and!or wor1 %er-orman,e2 Your statements will $e #i/en ,are-ul ,onsideration $y the sele,tion

%anel re/iewin# this a%%li,ation2 There-ore. your ,omments should $e as ,om%lete and detailed as

%ossi$le (atta,h additional %a#es i- ne,essary)2

1. A$$licants a?ilit to e and "er?all.

. A$$licants a?ilit to interact well wit# ot#er students and $rofessors.

%. A$$licants stren>t#s and wea=nesses as a $otential ee student.


10/10



'EE'ENCE O'M

,. A$$licants outstandin> or distin>uis#in> talents and c#aracteristics.

/. A$$licants $otential to si>nificantl contri?ute to t#e $u?lic sector in #is9#er #ome communit.

I here$y ,on-irm that the answers on this -orm are my own and re%resent my %ro-essional o%inion o- the

a%%li,ant2

i#nature o- /aluator Date

Documents

2014 Summer Institutes Application