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COMMUNITY COLLEGE INITIATIVE

STUDENT APPLICATION 2021-2022
Before completing this application, you must read all of the information at
https://co.usembassy.gov/es/education-culture-es/community-college-initiative-cci/. On this website, you will
find complete information about the Community College Initiative (CCI) Program, eligibility requirements,
application requirements, additional required documents that must be submitted, and deadlines.

Please complete all questions on this application in English. If the question does not apply to you, write N/A.

Personal Information
Full name (as listed on cédula)

First Name:
Second Name:
Last Names:

Address where you live Phone number:

Street and number:
City:
Department: E-mail:

Gender: Marital status: Date of birth:

☐ Single Month:
☐ Married Day:
Year:
Age:

Country/Countries where you are a citizen: Where were you born?

City:
Country:

Have you participated in any programs related to the U.S. Embassy? Yes ☐ No ☐
If yes, program name:

Year(s) you participated:

English Proficiency
English exam or certificate you are using to meet the English language requirement to apply for the CCI Program:
Name of English exam/certificate/program:
English level:

Remember that in order to be considered for the program, you must provide a certificate or results that clearly shows a
minimum B1 level or equivalent (Common European Framework).

Proposed Field of Study

Applicants must apply in only one field of study. Select your preferred field of study from the options below.
Then, select two or three concentration areas in that same field of study and note the order of your
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preference. The concentration areas all must be in the same field of study.

Field of Study Concentration Area Rank Order Preference

(choose 1): (choose 2 or 3): (1 is highest, 3 is lowest)

☐Agriculture ☐Agribusiness 1☐ 2☐ 3☐
☐Agricultural Geospatial Technology 1☐ 2☐ 3☐
☐Agricultural Production Management 1☐ 2☐ 3☐
☐Animal Science 1☐ 2☐ 3☐
☐Environmental Horticulture and Conservation 1☐ 2☐ 3☐
☐Parks and Natural Resources 1☐ 2☐ 3☐
☐Small Scale Food Production 1☐ 2☐ 3☐
☐Sustainable Agriculture 1☐ 2☐ 3☐
☐Applied ☐Architecture 1☐ 2☐ 3☐
Engineering ☐Automotive Technology or Service Management 1☐ 2☐ 3☐
☐Computer Aided Design 1☐ 2☐ 3☐
☐Construction Management 1☐ 2☐ 3☐
☐Electro Mechanical Technology 1☐ 2☐ 3☐
☐Electrical Systems Maintenance 1☐ 2☐ 3☐
☐Electrical Technology 1☐ 2☐ 3☐
☐Electricity and Electronics Technology 1☐ 2☐ 3☐
☐Heating Ventilation and Air Conditioning 1☐ 2☐ 3☐
☐Machine Repair: Automated Systems 1☐ 2☐ 3☐
☐Manufacturing Technology 1☐ 2☐ 3☐
☐Mechatronics 1☐ 2☐ 3☐
☐Robotics 1☐ 2☐ 3☐
☐Welding 1☐ 2☐ 3☐
☐Early ☐Administration of an ECE Center 1☐ 2☐ 3☐
Childhood ☐Early and School-Age Care Specialist 1☐ 2☐ 3☐
Education ☐Early Childhood Education and Development 1☐ 2☐ 3☐
☐Special Education 1☐ 2☐ 3☐
☐Information ☐Computer Information Systems (CIS)/Computer Science (CS) 1☐ 2☐ 3☐
Technology ☐Computer Internetworking Technologies (CIT) 1☐ 2☐ 3☐
☐Geographic Information Systems (GIS) 1☐ 2☐ 3☐
☐IT Technician: Desktop Support, Computer Support, Network Technician 1☐ 2☐ 3☐
☐Media ☐Digital Media/Animation 1☐ 2☐ 3☐
☐Film Studies/ Motion Picture/ Television 1☐ 2☐ 3☐
☐Graphic Design 1☐ 2☐ 3☐
☐Journalism 1☐ 2☐ 3☐
☐Public & Media Relations 1☐ 2☐ 3☐
☐Social Media Marketing 1☐ 2☐ 3☐
☐Web Design 1☐ 2☐ 3☐
☐Web Development 1☐ 2☐ 3☐
☐Public Safety ☐Fire Sciences, Protection and Safety 1☐ 2☐ 3☐
☐Emergency Services 1☐ 2☐ 3☐
☐Tourism and ☐Hospitality and Hotel Management 1☐ 2☐ 3☐
Hospitality ☐Culinary Arts and Restaurant Management 1☐ 2☐ 3☐
Management ☐Meeting, Event, and Exhibition Planning 1☐ 2☐ 3☐
☐Tourism 1☐ 2☐ 3☐
Background Information

Educational History

Are you currently a student? ☐ Yes ☐ No

Name of institution:
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How many semesters have you completed?

Please fill out the following chart based on your educational history. Start with your current or your most recent
institution. Please list information for your high school studies and for any studies (technical/vocational,
university, etc.) after high school.

Location of When did you When did you What is/was

Have you
institution start your finish your your area of
Name of institution received a
(city, studies? studies? study?
degree?
department) (Month/Year) (Month/Year)

Have you received a scholarship or funding for any of your studies? ☐ Yes ☐ No
If so, please describe the scholarship:

Work Experience
Are you currently employed? ☐ Yes ☐ No

List the jobs you have had, beginning with your current or most recent employment.

When did you

When did you
Name of company or start
Position title stop working? Job responsibilities
employer working?
(Month/Year)
(Month/Year)

Leadership and Community Service Experience

Leadership and community service are fundamental parts of the CCI program and the selection process. Please list any
experience you have as a volunteer and/or any experience as a participant or leader in extracurricular activities or
organizations.

.
When did When did
Leadership
Title or name of you start the you finish the Describe your involvement in this
position held (if
project/activity activity? activity? project/activity
applicable)
(Month/Year) (Month/Year)
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Have you ever traveled outside of Colombia? ☐ Yes ☐ No

If yes, please fill out the following information for any trips outside of Colombia:

Travel start Travel end

Purpose of travel:
date date Who paid for the expenses
Country/Countries visited vacation, studies, work,
(month/day/ (month/day/ related to your trip?
other (explain)
year) year)

How did you find out about the CCI Program? (Check all that apply.)

☐ U.S. Embassy social media

☐ Social media account of other institution
☐ Friend or family member
☐ EducationUSA
☐ Former grantee
☐ Other – please explain:
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QUESTIONS

For all questions below, please type your answers below or on the following page. Please follow the word
limits listed with each question.

Short Answer #1 (maximum 125 words)

Describe growing up in your home. Explain where you grew up, who lived in your home with you, what your
parents’ job responsibilities were during your youth (if they were employed), and what your surrounding
community was like.

Short Answer #2 (maximum 125 words total)

a.) What does leadership mean to you?
b.) Do you consider yourself a leader? If yes, what is an example of a time when you demonstrated leadership?

Short Answer #3 (maximum 125 words)

Please describe a problem or obstacle in your educational or personal life. How did you overcome it?

Short answer #4 (maximum 125 words)

The CCI Program prioritizes students from underserved or underrepresented communities. Describe how these
criteria applies to you.

Short answer #5 (maximum 125 words)

Describe a time when you have demonstrated the ability to go above and beyond what was expected of you.

Essay #1 (maximum 200 words total)

a) Within your proposed field of study, what specifically do you want to study? Describe your related
experience within the field you want to study.
b) How will this program of study build on your past education, training, and/or experiences in this field of
study? Alternatively, if you are new to this field, why did you choose this field?

Essay #2 (maximum 200 words)

How will your participation in the CCI program support your educational and personal development goals,
during and/or after returning from the program?
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COMMUNITY COLLEGE INITIATIVE PROGRAM

APPLICATION CERTIFICATION STATEMENT

I certify that I completed this application myself, that the information given in this application is complete and
accurate, and that I have carefully read and understand it.

I certify that I have read and I understand all of the information about the program on the U.S Embassy
Community College Initiative webpage:
https://co.usembassy.gov/es/education-culture-es/community-college-initiative-cci/.

I understand that program administrators reserve the right to verify all the information listed in the application.
I understand that giving false or misleading information in the application will eliminate me from the
competition or cause my dismissal from the Community College Initiative Program.

I acknowledge that I am aware of the following program requirements:

 I must follow all program rules and regulations and observe all the laws of the United States during my stay
there.
 At the end of the academic year program, I will return to my home country and fulfill a two-year, home-
country residency requirement in compliance with the terms of my J-visa. I understand that I may not
extend my program dates.
 The health benefits coverage provided to me during my travels is intended only for emergencies and does
not cover pre-existing or dental conditions.
 My spouse, children, other relatives or individuals are not permitted to accompany me to the United States
on the program.

_________________________________ ________________________________________
Signature of applicant Date (month/day/year)

Note: It is not necessary to print this form and sign physically. You may sign electronically by typing
your full name and the date in the spaces provided. By signing electronically, you agree to the entirety of
the certification statement on this page.