2020 U.S.

Department of State
Sport for Community: Global Sports Mentoring Program
Application Checklist

FULL NAME
DATE OF BIRTH
(MM/DD/YYYY)
GENDER Female Male

EGYPTIAN CITIZEN Yes No

Alexandria Fayoum Minia Sharqia

Aswan Gharbia Menoufia Sohag

Assiut Giza New Valley South Sinai

Beheira Helwan North Sinai Suez

GOVERNORATE
Beni Suef Ismailia Port Said 6th of October
Kafr El
Cairo Qalyubia
Sheikh
Dakahlia Luxor Qena

Damieatta Matruh Red Sea

PREVIOUS TRAVEL TO THE U.S.?

If yes, state duration and type of visit

YEARS OF WORK EXPERIENCE

CURRENT EMPLOYER
LEVEL OF EDUCATION
(Bachelors, Masters, Phd, or other degree)

In order for your application to be complete, make sure you have:

Completed Application Checklist Form (this page)
Completed Application Form
Copy of National ID and/or passport
Updated Curriculum Vitae/Resume
Two Recommendation Letters

APPLICATION DEADLINE: DECEMBER 18, 2019

 Sport for Community: Global Sports Mentoring Program
Application Form 2020

APPLICATION INSTRUCTIONS

 All applications must be typed, completed in full, and in English by the applicant. Hand-written or
incomplete applications will not be considered.

 All essays should be type-written in English. Essays must be written in the applicant’s own words and
not contain text taken from the internet, books, or other sources. Applications containing even one
sentence of plagiarized text will be disqualified automatically. For a definition of plagiarism and
how to avoid plagiarism please visit www.plagiarism.org for guidance.

 Recommendation Letter: Applicants may include two letters of recommendation. The recommender
can be from employer or NGO. The recommender must provide the applicant with the letter and it is the
applicant’s responsibility to include this letter as a part of his/her application.

 SUBMISSION: Applications must be received by post, or in person as explained below by December

18, 2019 by 2:00 pm. Applications received after the deadline or electronically will not be
considered.

o On the front of all envelopes, you must write your name and the program name.

o Postal Submission: Mailed applications must be sent by a dependable courier service that
requires signature upon delivery.

o Hand Delivered Submission: Hand delivered applications will be accepted at the U.S.
Embassy in Cairo Sunday through Thursday between 11:00 a.m. and 2:00 p.m. on work days
only. Applications must be HAND delivered in OPEN envelopes to the checkpoint guard at the
North Gate of the U.S. Embassy (8, Kamal El Din Salah Street, Garden City).
*The US Embassy in Cairo is closed on Fridays and Saturdays

o Please use the following address on all envelopes:

U.S. Embassy in Cairo, Public Affairs Section, Exchanges Office

North Gate, 8 Kamal El Din Salah Street, Garden City, Cairo, Egypt

REMARKS: Please keep an electronic type-written copy of the completed application. Applicants contacted for
interviews will asked to send their applications by e-mail.

INQUIRIES: Inquiries should be sent by email to CairoProfexchanges@state.gov Inquiries will be answered

within 2 business days. More information about the S4C: https://globalsportsmentoring.org/sport-for-community/

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 Sport for Community: Global Sports Mentoring Program
Application Form 2020

BIOGRAPHICAL INFORMATION

PREFIX (DR., MR., MRS., MS.):

NAME (exactly as spelled in the passport):
ADDRESS:
CITY:
EMAIL ADDRESS:
HOME TELEPHONE: PERSONAL MOBILE:
CITIZENSHIP:

PASSPORT NUMBER:
DATE OF ISSUANCE (MM/DD/YYYY):
DATE OF EXPIRATION (MM/DD/YYYY):
CITY OF BIRTH: COUNTRY OF BIRTH:

NATIVE LANGUAGE:

ENGLISH PROFICIENCY:
SPEAKING:
COMPREHENSION:
WRITTEN:

LIST ANY MEDICAL, PHYSICAL, DIETARY OR OTHER PERSONAL CONSIDERATIONS.

PREFERRED MAILING ADDRESS: HOME BUSINESS

SOCIAL MEDIA: List social media account names where applicable.

TWITTER:
FACEBOOK (personal account):
FACEBOOK (organization account):
INSTAGRAM:
OTHER:

PREVIOUS EXPERIENCE ABROAD AND IN THE UNITED STATES: List all travel abroad, including the
United States. Please note if you have ever traveled on a U.S. government program
Arrival Date Departure Date
City/ Country Purpose
(MM/YYYY) (MM/YYYY)

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 Sport for Community: Global Sports Mentoring Program
Application Form 2020

PROFESSIONAL BACKGROUND

FULL NAME OF CURRENT EMPLOYER:

ADDRESS:
CITY:
PHONE: FAX:
BRIEF DESCRIPTION OF COMPANY/INSTITUTION: Include information on the organization's sector
(private, public, non-governmental), number of employees, mission, annual budget, annual revenue,
relevance to people with disabilities through sports, and website.

PRESENT POSITION: Please use exact title.

STARTING DATE:
BRIEF DESCRIPTION OF YOUR ROLE IN COMPANY/ORGANIZATION:

PROFESSIONAL MEMBERSHIPS Please list all memberships in local, national or international professional
organizations, associations, or clubs. These should not include professional duties directly related to current
employment. Please select your position type from the drop down menu and complete the table accordingly.

Position/ Title Organization Years Active

EDUCATION: List all education, academic and professional training. Include degrees earned and fields of
specialization beginning with most recent. Degrees listed should reflect the closest U.S. equivalent.

Year
Degree Earned Specialization / Institution
Earned

Other Interests and endeavors outside of work: (Hobbies, Volunteer Activities, etc.)

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 Sport for Community: Global Sports Mentoring Program
Application Form 2020

PERSONAL STATEMENT

This can be more than one page, but you must answer all six of the following questions in your
personal statement in order as listed below.
1. Why will you be a good fit for this exchange program?
2. What do you hope to gain from the mentorship experience?
3. How will you maximize the opportunity?
4. What are your accomplishments and contributions to society (particularly in the context of
sports and empowerment for people with disabilities)?
5. What are your personal, executive, and technical strengths?
6. How do you expect the program to impact your work when you return to Egypt?

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 Sport for Community: Global Sports Mentoring Program
Application Form 2020

REFERENCES

Identify at least one additional individual who can serve as a reference, other than the ones who provide
recommendation letters.

Name
Title
Mailing Address
Telephone Number
Email Address

Name
Title
Mailing Address
Telephone Number
Email Address

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