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Fulbright Commission UK Summer Institute Draft Application 2015

*Please note: We highly recommend you use this form as an opportunity to create a rough draft of your
application for your records and use. This form is almost a complete replica of the online application form. You
must submit an online application via the link from the programme website, and send the supplemental
materials to the listed e-mail in order to apply. Please be sure you have reviewed the webpages and
application instructions for details before beginning your online application.
Programme Details
Which institute are you applying for? You may only state one
     
Personal Details
Title:      
Last Name:      

First Name:      

Permanent Address:      

Term Time Address:      

Is this your primary contact address? Yes
Zip Code:      
State:      
Telephone:      

Middle Name(s):      

No

Cell Phone:      

Place of Birth:      

Is this your primary contact address? Yes
Zip Code:      
State:      

No

Email Address:      
Citizenship (s):      

Current Academic Details
Current Academic Institution:      
Address:     

Degree Programme/Major & Minor:      
Present Academic Level (tick one):
Freshman (Rising Sophomore)
Sophomore (Rising Junior)

Zip Code:      

State:      

Expected Graduation Date (month/year):      

Current GPA:      

Emergency Contact Details
The emergency contact data will be used only for emergency purposes e.g. in the event of an accident whilst
on the programme. You should notify the individual you have named below that you have provided us with this
information and we will hold this information on file, if you are selected. The emergency contact will only be
disclosed in emergency situations to appropriate 3rd parties, e.g. ambulance service, hospital and the police, in
your immediate health or safety interests. Please notify the Commission immediately if this information
changes.
Name:      
Relationship to you:      
Address:      

Telephone:      
Cell Phone:      
Email Address:      

Zip Code:      

State:      

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school trip/ vacation/ visit family)                                                                               Have you ever attended a Summer School before? Yes No If yes.g. please list the programme name.e.       2. Please be advised that the process for applying for a US passport can take between four and six weeks. year and location:       US Passport All participants must have a valid US passport to take part in the Summer Institute. Yes No In progress How far along are you in the process?       Extra-curricular Activities Please list all extra-curricular activities from the last four years: (attach one separate sheet if necessary) Date From       Date To       Organisation       Position Held/Award Given and Duties/Description                                                                                                                               Self-Assessment: Assessing Yourself by Threes Please complete this section fully. What are three areas in your life that you are passionate about? 1.       2 .Have you ever travelled outside of the United States? Yes If yes. until end of Feb 2016). Please confirm that you have a valid US passport that will still be in date 6 months after you return from the programme (i. please list all countries: (attach a separate sheet if necessary) No Date Country Length of stay                   Reason for travel (e. there are no trick questions or correct answers.

applications that are incomplete or missing any required supplemental materials will not be considered. 3 .       3.       2.       What are three things that you would change about your life if you could? 1.       3.3.       3.       2.       2.       How do you think your friends would describe you? Write about the nicest thing that you have ever done to help someone else Write about a time that you let someone else down and how you feel about it now What qualities or skills do you have to offer to your host institution community? All applicants: Please read the following section carefully along with the application instructions.       List three adjectives to describe yourself 1.       3.       What are your three best qualities? 1.       2.       What are your three greatest weaknesses? 1.

Please make sure you discuss why you are interested in studying in the United Kingdom and what you hope to gain from the experience. application instructions and FAQs for more information on Transcripts and Reference letters. Using one or more examples. Describe a situation in which you have had significant responsibility and what you learnt from it.Personal Statement Please complete a personal statement. 3. 4. Think of a time when you have found something particularly challenging. please discuss a current affairs issue in the United States that is important to you. Essay Question Please complete an essay on the following pages based on one of the questions below: 1. 2. Describe something that you have observed or experienced which has had a significant impression on you. How did you approach that situation and what steps did you take to overcome those challenges? Academic Transcript/Confirmation of Grades and References Please refer to the website. 4 .

5 . Your personal statement must not be longer than the space this box permits.Personal Statement Please make sure that you review the detailed instructions to complete the personal statement.

Your essay must not be longer than the space this box permits. Essay number: 6 . Please indicate which essay question you have answered.Essay Question Please make sure that you review the detailed instructions to complete the essay.

Equal Opportunities Monitoring Form: UKSI 2015 The Fulbright Commission is committed to the promotion of equality of opportunity in all aspects of its policy. by analysing statistical information. The information you provide will not be used as part of the recruitment selection process. or if you prefer these considerations can be discussed if you are successful after the interview. Please detail any relevant information below. Last Name:       First Name:       Gender: Male Female Date of Birth (dd/mm/yyyy)       /       /       Age at start of the programme       Middle Name(s):       Prefer not to say Ethnic Group Tick the appropriate box to indicate your ethnic background White African American and White Black or African American Asian American and White Asian or American Asian Hispanic and White Hispanic or Latino American Indian and White Native American or Alaskan Native African American and Hispanic Native Hawaiian & Other Pacific Islander African American and Asian Other ethnic background Please specify:       Parent/Guardian Education Tick the appropriate box to indicate the highest level of education achieved by your parents/guardians High School Associate Degree Bachelor’s Degree Postgraduate Degree None Prefer not to say Disability Do you consider yourself to be disabled? Yes No Prefer not to say Programme Promotion Where did you see/hear about this programme? Fulbright Commission Website Flyer or Poster Word of Mouth Previous Applicant Email Academic Advisor The organisers of the programme have requested information regarding any medical. but will enable the host institution to make any necessary accommodations. To make this meaningful we need to monitor the effectiveness of our policies. It will only be viewed after your interview by the programme administrator. if you are successful in obtaining a place on the programme to complete your application with the host university and for statistical purposes. which will ensure our statistics are accurate and representative of people who are seeking programmes and awards through the Fulbright Commission.       7 . We would be grateful if you could provide us with the following information. This will not affect candidate selection. This form will be kept separate from your application form and treated in the strictest confidence. practices and procedures. dietary or other personal considerations that any successful applicants would require. physical.

8 .Confirmation of Documentation Please use this checklist to confirm that you have completed all of the following sections and included all of the necessary documents in your email.org.  UK Summer Institute Application Form  Self-Assessment: Assessing Yourself by Threes  Personal Statement  Essay Question  Equal Opportunities Monitoring Form  Academic Transcript  Two Letters of Reference Any questions.uk Applications must be received in full by: February 26 or March 5 (depending on your programme choice) by 5pm (UK Time) Late applications will not be considered under any circumstances. please e-mail: programmes@fulbright. Incomplete applications will not be considered by the Commission.