2016 Benjamin Franklin Transatlantic Fellows

Summer Institute for Youth

APPLICATION

A. Last (family) name as on passport:

B. First name as on passport:
C. Middle name(s) as on passport:
D. Date of birth (month/day/year please spell out the month):
E. City of birth:
F. Country of birth:
G. Country of residence:
H. Country of citizenship:
I. Gender:
J. Position (Choose from "Secondary School Student", "University
Undergraduate Student", or "Special School, Institute, or Vocational
Student".):
K. Nominees full address:
L. Home telephone number and mobile phone number:
M. E-mail address(es):

N. Medical, physical, dietary, or other personal considerations (Please

describe any pre-existing medical conditions, including any prescription
medication the candidate maybe taking, or any other dietary or
personal considerations. This will not affect candidate selection, but
will enable the host institution to make any necessary
accommodations.):

O. Name of nominees high school or college/university:

P. Nominees field of study (if applicable):
Q. Any other relevant educational, academic and professional
experience or training:
R. Active memberships, special interests, or extracurricular activities
(please list your achievements, competition results, volunteering):
S. Previous travel or study experience in the United States. Please
include dates and purpose:
T. Evidence of competence in written and oral English (e.g. school
grades):
U. Future study or career plans:
V. Essay #1 (in no more than 700 words please answer below):
Why are you an ideal candidate for this program?
W. Essay #2 (in no more than 700 words):
If you could go back in time, where would you go and why?
To apply: Completed application (together with two essays - 700 words maximum
each), two recommendation letters (teachers, trainers, coaches ), academic records

from the last year should be sent to the U.S. Embassy by March 5, 2016.
Incomplete applications will not be accepted. Please do not send copies of awards,
diplomas etc. (please list all your achievements under R. in this application).
Please send complete documentation to the email only:
benfranklin@usembassy.rs
You

should receive

an automatic

email reply when you send your

application, confirming that your application was received.

Only short-listed candidates will be invited for an interview.