2020 STUDY OF THE UNITED STATES INSTITUTES

SUSI SECONDARY SCHOOL EDUCATORS

Application Checklist

CANDIDATE NAME

CURRENT POSITION

CURRENT EMPLOYER

AGE
GENDER

Alexandria Fayoum Minia Sharqia

Aswan Gharbia Menoufia Sohag

New South
Assiut Giza
Valley Sinai
North
Beheira Helwan Suez
Sinai
GOVERNORATE
6th of
Beni Suef Ismailia Port Said
October
Kafr El
Cairo Qalyubia
Sheikh
Dakahlia Luxor Qena

Damieatta Matruh Red Sea

 2020 Study of the United States Institutes (SUSI) – Secondary School Educators

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

Completed Application Checklist Form (this page)

Completed Application Form including the Personal Statement

Nomination Form (Last page of the Application Form)

Copy of National ID and/or passport

Updated CV/Resume

Two Recommendation Letters

English fluency test scores from Institutional TOEFL (Local ITP), Internet-based TOEFL
(IBT), or overall International English Language Testing System (IELTS).

APPLICATION DEADLINE: January 15, 2020

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 2020 Study of the United States Institutes (SUSI) – Secondary School Educators
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.

 The Nomination Form is part of the application. The nominator can be academic (dean, professor
or advisor), or professional (supervisor).

 Recommendation Letter: Applicants may include up to two letters of recommendation, but these
are optional. The recommender can be academic (dean, professor or advisor) or professional (work
supervisor) but recommender must be different than the person completing the nomination form. 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 January

15, 2020 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, the program name, and the institute.

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 CairoSUSI@state.gov Inquiries will be answered within
2 business days. Applicants are encouraged to visit the following link to obtain general information about
the Institutes: http://exchanges.state.gov/susi

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 2020 Study of the United States Institutes (SUSI) – Secondary School Educators
Please select only one of the following institutes:

Secondary Educators (Teachers)

Secondary Educators (Administrators)

BIOGRAPHICAL INFORMATION

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

NAME (EXACTLY AS SPELLED IN THE PASSPORT):

CURRENT POSITION:

EMPLOYER:

HOME TELEPHONE: MOBILE:

ADDRESS: CITY:

EMAIL ADDRESS: DATE OF BIRTH (MM/DD/YY):

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

EMERGENCY CONTACT:
NAME: RELATIONSHIP:

PHONE: E-MAIL:

PREVIOUS EXPERIENCE IN THE UNITED STATES

Purpose Arrival Date Departure Date Purpose

LIST IMMEDIATE FAMILY MEMBERS CURRENTLY RESIDING IN THE UNITED STATES

Name Relationship City State

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 2020 Study of the United States Institutes (SUSI) – Secondary School Educators

ENGLISH EDUCATIONAL BACKGROUND

PROFICIENCY (at least one of the following tests has to be completed with a valid score)

Institutional TOEFL (Local ITP)

Score: Date Test Taken:

Internet-based TOEFL (IBT)

Score: Date Test Taken:

International English Language Testing System (IELTS).

Score: Date Test Taken:

EDUCATION: List 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.

Degree Earned Year Earned Specialization/Institution

WHAT ARE YOUR ACADEMIC/PROFESSIONAL GOALS FOR THE NEXT 5 YEARS?

DESCRIBE HOW YOUR WORK IS RELEVANT TO U.S. STUDIES AND THE SPECIFIC
INSTITUTE THEME.

POTENTIAL PROGRAM OUTCOMES: Select any likely potential professional outcomes of this program.
Update Existing Course Raise Institutional Profile
Create New Course New Institutional Linkages
Create New Degree Program New Research Project
School Curriculum Redesign National Curriculum Redesign
New Publication New Professional Organization
Professional Promotion Government or Ministry Policy

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 2020 Study of the United States Institutes (SUSI) – Secondary School Educators
PROFESSIONAL BACKGROUND

CURRENT TITLE:

SCHOOL/INSTITUTION NAME:

INDICATE YOUR POSITION TYPE BY SELECTING ONE CHOICE FROM THE FOLLOWING:
Public Secondary School Teacher
Private Secondary School Teacher
National Curriculum/Exam Developer
Teacher Trainer
Textbook Writer
Other. Please specify:

PROFESSIONAL RESPONSIBILITIES: Include research interests, administrative responsibilities (ex. curriculum

design), and/or other pertinent information.

CURRENT COURSES: Include all courses currently being taught by you. (Add attachments if required.)
Estimated
Level of Classroom Hours
Name of Course # of Students Percent of US
Student per Semester
Studies Content

CURRENT STUDENT ADVISING: Advising is not the same as teaching. We are looking for the number of
students, their level, and hours spent helping students clarify personal and career goals, and evaluating progress
towards those goals. This section can also include supervised PhD and graduate students.
Number of Students Advised studying Hours of Advising
Level of Students
U.S. related Topics per Student per Year

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 2020 Study of the United States Institutes (SUSI) – Secondary School Educators

CURRENT EXTRA-CURRICULAR/CO-CURRICULAR ACTIVITIES:

Position/Title
(Please choose START END
Activity Description of Duties
one option from MM/YY MM/YY
below)

LIST YOUR PREVIOUS WORK EXPERIENCE – Include previous positions, titles, and time periods.
Start End Title/Institution
Date Date (Please specify if position is part-time)

LIST YOUR PUBLICATIONS RELATED TO THE INSTITUTE THEME. All Arabic titles should be
translated into English. Identify publication type via the dropdown menu. (You can list up to 10 publications.)
Publication Type Year Title/Publisher

ADDITIONAL PROFESSIONAL TRAINING:

LIST ACTIVE PROFESSIONAL MEMBERSHIPS INDEPENDENT OF CURRENT PROFESSIONAL

RESPONSIBILITIES. These should not include university committee work or other professional duties
directly related to current employment. Select position type from the drop down menu and complete accordingly.
Position/ Title Organization Years Active

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 2020 Study of the United States Institutes (SUSI) – Secondary School Educators

ESSAY

Please discuss why you wish to participate in this program by discussing: (Limit 250 words)
(1) Your current personal teaching philosophy
(2) How your participation will enhance your work
(3) How your participation will improve education about the United States in your community
(4) How your participation will help you achieve the "Other Potential Outcomes" you mentioned in
the Educational Background section of the application.

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 2020 Study of the United States Institutes (SUSI) – Secondary School Educators

NOMINATION FORM

Employer Nomination Form

NOMINEE’S FULL NAME:

EMPLOYER:

NOMINATOR’S INFORMATION
NAME: POSITION:

EMAIL ADDRESS: TELEPHONE:

HOW LONG AND IN WHAT CAPACITY HAVE YOU KNOWN THE NOMINEE?

YOUR QUALITATIVE EVALUATION WILL BE USED IN ASSESSING THE CANDIDATE. PLEASE

FILL OUT THIS SECTION CAREFULLY.

Nomination Criteria Outstanding Very Good Good Average

Knowledge in Field Of Chosen Institute

Seriousness of Purpose

Oral English Language Proficiency

Written English Language Proficiency

Career Potential

Creativity

SELECTION TO THIS PROGRAM IS HIGHLY COMPETITIVE. EXPLAIN WHY YOU FEEL THIS
CANDIDATE SHOULD BE SELECTED WITH REFERENCE TO HER/HIS PROFESSIONAL PLANS:

Signature of Nominator Date:

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