PRELIMINARY APPLICATION FORM 2021-2022

Kennedy-Lugar Youth Exchange & Study Program (MOZAMBIQUE)

Welcome!
The Kennedy-Lugar YES Program has a rigorous application process. Great care
is taken to match your interests and needs with the program, the country and the
host family that is right for you. This Program is specific for the USA.

Step 1 (the Preliminary Application – this form starts the process. It tells us that
you want to participate in an exchange experience to the USA. All Items must be
filled in properly. An application is only considered completed when the following
documents are submitted – (a) The preliminary application, and (b) the last two (2)
years of school reports for 2018 and 2019.
NO INCOMPLETE APPLICATION FORMS WILL BE CONSIDERED! When we
receive the completed application, an initial pre-screening will be done. If your
application is approved, Part 2 (the Full Application) will be given to you. Write
clearly and legibly.

Step 2 (the Full International Application) is essential as your answers help us further determine your
eligibility and suitability for an exchange experience. If you are finally selected for the YES program, some of
the information you give in this Full Application (approx. 20 pages) will be the first information provided to the
host country and the host family. If you pass this step, you will be informed and called to an Interview.

Step 3 (the Interview Stages) provides valuable input for us to make the final selections. A panel of volunteers
will meet with you and interview and evaluate you on the basis of certain criteria. This gives you an opportunity
to learn more about our organisation and to begin thinking about what you want to gain from the program. It
also gives us the opportunity to learn more about you and what you are looking for in an intercultural exchange
experience.

These Individual Interviews plus Home Visits or Family Interviews lead to a merit-based national ranking of all
applicants and to a selection of finalists that will be offered a chance to participate in an exchange program.
The order of these steps may be altered according to regional preference where you reside.

Good luck!
PLEASE FILL IN THE FORM IN ENGLISH AND PRINT IN BLOCK/CAPITAL LETTERS

PERSONAL INFORMATION

X Male Female Date of birth: Day ___03__ Month ___June____________________ Year 2005______

I am currently studying in (9th, 10th, 11th grade):_____10th_______________

Country of Birth ____Mozambique _________________________ Country of Citizenship:_____Mozambique

___________________

Name (First / Middle / Last) ____________Allan Malik das Foca Mudhlovo____________________

Home Address (with Postal code):__Rua da Mozal, CL A, Q1, 9002, Matola-Rio_______

_____________________________________________________________________________________
_____________________________________________________________________________________

Home Telephone or Contact person’s phone_+258 828781440__________________________________

Email address_mudhlovo2005@hotmail.com________________________________________________
If you do not have an email address, please provide one from your family member or friend. This email is very important to
inform you about the status of your application, do not change it.

Important! If you have an email address, this information must be given now, as most of our
communication is by email. If you do not have an email address, YOU MUST OBTAIN one.
DO NOT LEAVE ANY BLANKS AND FILL THE FORM NEATLY otherwise you will be
disqualified. WRITE N/A OR A LINE WHERE DOES NOT APPLY TO YOU. PLEASE SUBMIT
THIS APPLICATION TO YOUR LOCAL REPRESENTATIVE BY 30 SEPTEMBER 2020.
 PRELIMINARY APPLICATION FORM 2021-2022

FAMILY INFORMATION
Names and Ages of parents or guardian and siblings with whom you live (D.O.B means Date of Birth):

Father/male guardian Name (First / Last) ___Jean Mudhlovo ____________D.O.B.: 24 April 1983

Mother/female guardian Name (First / Last) _____Rosita Mudhlovo________________________________

D.O.B.: 30 May 1985_________

Sisters (Name / D.O.B.) Leandra Mudhlovo – 12 June 2013

____________________________________________________________________

Brothers (Name / D.O.B.) _N/A_______________________________________________________________

Does anyone else live at home with you? YES NO X Who? Relationship? Ages?
______________________________________________________________________________________

______________________________________________________________________________________

Has anyone in your family ever participated in an exchange program? Name

N/A____________________________

Relationship to you __N/A_________________ Country____N/A____________

Year____N/A___________

What religion are you: Hindu Islam Jain Sikh Parsee X Christian Other:_________________
Do you need a access to a place of worship when abroad? If yes, please specify:
_N/A____________________
______________________________________________________________________________________

Are you vegetarian? YES X NO. Specify what you cannot eat: Beef Pork Fish Poultry
Dairy/eggs Non – Halal meat Onion/garlic Root veg. other (specify) _________________
Please explain why you cannot eat any of above ticked (Ex. Fasts, prayers, religion, health, etc.)
__N/A_________________________________________________________________________________

Note that in many areas, due to distance, availability and costs access to places of worship,
vegetarian food and Halal meat are not always easy to obtain. While host families will
usually try to accommodate your needs, you may need to be flexible.

In a host community, are you willing to eat?: X Beef X Pork X Fish X Poultry X Dairy/eggs X Vegetarian

Father’s occupation ___Bulding Administrator_____________________Place of work:

Maputo___________________________

Company name: Spanish Agence for international Cooperation and Development – AECID Phone: + 258
828781440
Email address:_ mudhlovo2005@hotmail.com______________________________________________

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Mother’s occupation _Monitoring and Evaluation Officer _ Place of work: Cabo Delgado
_________________________________

Company name:TOTAL Phone:+258 829189900__________________________

Email address: rnhamizinga@gmail.com ______________________________________

SCHOOL/PUC INFORMATION (Where you are currently studying)

School Name Externato Completo 3 de Maio______________________________________________

School Address(incl city or town) Rua da Mozal – Boane ____________________________________

______________________________________________________________________________________
______________________________________________________________________________________
School Telephone +258 844788513_______________________________________________________

Principal’s Name _Gabriel Massango____________________________________________________

School grade last completed? (Ex. 9th,10th)__________9th____________________________

Average (0-20 Marks) in last 2 years (Example: 8th-15Marks, 9th – 14Marks)_8th -16 Marks, 9th -15 Marks
Extracurricular Activities at School/PUC___N/A_______________________________________

HEALTH INFORMATION
Have you ever been hospitalized? If yes, for what and when?__N/A___________________________________
______________________________________________________________________________________

Do you have any illness for which your take medication regularly/occasionally?___No_____________________
If yes, describe ___N/A______________________________________________________________________

Do you have any medical (including mental) condition or disability, any allergies? If yes, describe_________
____N/A_______________________________________________________________

LANGUAGE INFORMATION
List all African languages and foreign languages that you speak/ understand/ write, and rate your fluency
as fair, good or excellent. (In parenthesis for each one)_(Portuguese – Write excellent, read excellent, speak
good), (English – Write good, read good, speak fair)______________________________________
______________________________________________________________________________________

Have you ever traveled within Mozambique? Where? When?

Yes. To Beira (2018), Tete (2009), Manica (2018) and Gaza (2014)

Have your ever traveled abroad? Where? When? __No______________________

Do you have a valid passport? Yes X No If yes, Passport

Number_______N/A______________________
Date Passport was issued:_____N/A__________, Date Passport expires:_____________N/A______________

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 PRELIMINARY APPLICATION FORM 2021-2022

HOBBIES/ FREE-TIME ACTIVITIES

What do you do in your free time? _______ Drawing, participates in drawing contests, read books (manga
preferable) and play soccer.___________________________________________________
______________________________________________________________________________________

Name any organizations or social services you are involved in _N/A_________________________

_________________________________________________________________________
List any special roles or achievements
____N/A______________________________________

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 PRELIMINARY APPLICATION FORM 2021-2022

Thank you and good luck!

KL YES ESSAY 2021 – 2022

NAME OF APPLICANT:____Allan Malik das Focas Mudhlovo________________

Instructions

Please answer all three questions. Should you run out of paper kindly use another page and label is
appropriately. This is not an ENGLISH test. Please include a word count at the bottom on the essay.

1. Describe a time in your life when someone has disagreed with something you feel strongly about. What did
you do?
2. If you become a YES student you will stay in the USA with a host family. You will not be a guest. Explain
what you would do to become part of your host family and your host school.
3. Why would you like to be selected to take part in the KL YES programme?

1. A recent discussion with my friends was about the idea that you can't define someone by what he
looks like. To be more specific, we were discussing what to think about a man painting his nails. From my
friends only women can do that, and if I, as a man, paint my nails people might start asking about my
sexual orientation. As I don’t agree with that opinion, I brought to them some examples of men who
appeared with characteristics considered as for women such as long hair, ear rings or men that wear pink
and show them that one thing don’t necessarily lead to another. Some people agreed with me and
changed their opinion and the other not really. So what I did was learn from that experience that each
one has their beliefs and I should respect them as I would like people to respect mine and if some one
can't prove me or argue about his position I will not have bases to change my opinion.

2. First of all I would make the maximum effort to learn the language. I understand that communication is
the first step to have access and become more accessible to the family and all people that somehow I will
be related. The second thing to do is understand the country and community culture through reading and
socialization. This will also help me to understand the habits and the context these people live in. It will
also help me to break some barriers I will take with me and open new horizons of diversity. I will do the
best to adapt to their routine, create mine and also create a circle of friends. I will be respectful and I will
comply with my duties, obligations and responsibilities and identify ways to help and contribute in house
and at school through participation in positive and creative initiatives.

3. I would like to take part of KL Yes program because is a chance to:

• Interact with people with different culture: I consider myself as an introverted person and I Iike to
observe unexpected thing. I believe we can learn much more when we think out of the box. The idea of
speak another language and knowing different people with different culture seems to be a very promising
learning source to me
• Learn in different ways - experience other methodologies of learning will allow me to open my mind,
and I hope to apply these skills for the rest of my student life
• Have a different life experience - It would be the first time living without my parents. I believe that
would lead me to be more responsible, learn the importance of having good relationship with other and
also it’s a beginning to become independent
• Bring new vision to my life and country - This will be useful to all the decisions I will take once they will
be oriented to the new mentality I will have. As the country in reference is very developed, I will try to get
the maximum from what they offer and I will replicate this to achieve my life goals.

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 PRELIMINARY APPLICATION FORM 2021-2022

STUDENT GRADE TRANSLATION

STUDENT AND SCHOOL INFORMATION

School Name: ______________________________________________________________________________

Town/City: _________________________________________________________________________________

Is this a boarding school? □ YES □ NO

Type of school: □ PUBLIC □ PRIVATE □ OTHER, Explain:___________________________________

ACADEMIC YEAR ACADEMIC YEAR ACADEMIC YEAR

2018 2019 2020

SUBJECTS FINAL YEAR MARK FINAL YEAR MARK APRIL EXAMS MARK
Portuguese 16 14

English 14 15

French 15 15

History 16 14

Geography 15 14

Biology 17 15

Agribusiness 16 17

Physics 17 14

Chemistry 16 16

15 14
Mathematics
16 14
Visual Education
15 17
Phisical Education
Entrepreuneurship 15

TIC´s 15

Average Mark (0-20 Marks) over the 2 years period (2018-2019): _____15.5_____

Please enclose copies of the end of year reports for 2018 and 2019 (without
which your application form will be incomplete).

To start the application process, please submit this preliminary application and copies of your I.D. copy and end
of year reports cards to Arsénio Penga arsenio.penga@afs.org (84 504 6089) or Max Mangue (84 636 6133) in
MAPUTO, Valter Serafim valterserafim2013@gmail.com (84 788 0603), or Dr. Narciso Saeze at Instituto de
Línguas in NAMPULA, Rogério Iassine (84 748 8959) in Pemba or Roberto Manuel (84 575 8307) in Beira.
This must reach us BEFORE 30 September 2020.

Thank you and good luck!