YSEALI Academic Fellowships Application
Incomplete applications will not be considered.A. Applicants
Full Name, exactly as it appears in passport: Prefix: Choose an
item.Last Name: First Name: Middle Name: B. Gender:
C. Date of Birth : Click here to enter a date.D. Place of Birth:
E. Country of Birth: F. Citizenship
Primary
: Secondary : (if applicable)
G. Current County of Residency: H. Medical, Physical, Dietary or
other Personal Considerations: Disability:
Please describe any pre-existing medical conditions, including
any prescription medication the candidate may be taking, or any
other dietary or personal consideration. This will not affect
candidate selection, but will enable the host institution to make
any necessary accommodations.
I. Applicant Contact Information:
Address
: City
: Province
: Postal Code: Country
: Email
: *if you do not have an active email address, please create one
prior to submitting your application, and indicate it here
Phone
: Emergency Contact Phone: Emergency Contact Name and
Relationship:
*Example: John Doe, Father
J. Academic Major, Institution/University:-Major
: -Home Institution
: Country Name-Institution/University: K. Work Experience,
including previous positions, titles, institutions, dates of
employment (dd/mm/yyyy), and part/full time position:
FromToTitle/Institution (Please specify if position is part
time)
L. Volunteer Experiences :
FromToTitle/Institution
M. Year in School (or Semester in School) and Expected
Graduation Date, or date degree attained if already graduated:
Click here to enter a date.N. Memberships in Associations,
Clubs, etc., including position type, title, and
Organization name:*Please include dates (example: Student
Government, May 2011 to June 2012)
O. Previous Experience in the United States: Have you travelled
to the U.S. before?
If yes, please fill out the following section
From: Click here to enter a date. To: Click here to enter a
date.Purpose:
P. Family Residing in the United States:
Do you have close family residing in the U.S.? If yes, please
fill out the following section; if no, please write None.
*Please include city and state (Example: John Doe Chicago,
IL)
Q. Evidence of English Fluency: (Please note if you have taken a
language proficiency test, lived abroad, or taken English language
courses. If you have taken any language proficiency test please
provide the date it was taken and your test score if you have taken
English language courses please indicate your level of English in
the course.
R. Please check to which institute you are applying (only one
may be checked)
Civic engagement
Environment and natural resources management
Entrepreneurship and economic development
S. Personal Statement by Candidate:
Tell us about yourself and your goals including the following:
What about your background and/or interest makes you competitive
for this particular institute (please be as specific as possible)?
What will you contribute to the group? How do you expect this
experience will affect your future academic and professional
career? How will it affect you personally? Please attach your
response, limited to 250 words, and submit along with this
completed application and one letter of recommendation from someone
who knows you well, to [email protected]. Nomination Due: June 1,
2015Questions? Call: (021) 3435-9641; E-mail:
[email protected]
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