STUDY OF THE UNITED STATES INSTITUTES (SUSI)

Study of the U.S. Institutes for

Student Leaders on Civic Engagement

A. Title of the Institute: Study of the U.S. Institute for Student Leaders on Civic Engagement
B. Last name:___DIALLO__________________________________
C. First Name:___Pinda__________________________________
D. Middle Name:____________________________________
E. Gender:_____female____________________________________
F. Date of Birth:_20 aavril 2002___________________________________
G. City of Birth:___Bamako_________________________________
H. Country of Birth:____Mali_____________________________
I. Citizenship:___Malian___________________________________
J. Residency:___family house____________________________________
K. Medical, physical, dietary or other considerations:_______________
L. Address:_Bacodjicoroni_steet:512__________________________________________________
___________
M. Telephone:____(+223)74308178______________
N. email:_piluch8@gmail.com____________________________________
O. Emergency contact Name and relationship___Mother
P. Nana Traore____________________________________
Q. Emergency contact phone number:___(+22374308178)_______________;email: (if
any)_____________________
R. Academic Major, Institution
Major:__COMPUTER SCIENCE________________________________________
Institution Country Name_Mali____________________________
Institution Name : INSTITUT DE TECHNOLOGIE ET DE
MANAGEMENT__________________________________________
University level: _2sd year licence ________________________________________
Number of remaining semester at the university:__three__________________________
S. Education, Academic and Professional Training:

Degree Earned Year Major

GOOD 1YEAR HTML/CSS
GOOD 1YEAR PYTHON PROGRAMING

T. Work and Volunteer Experience:

Please send your filled form at: bamakoscholarships@state.gov

 Year Title Type of Work or Volunteer experience

U. Membership in Association, Clubs, etc. (Include any Active Memberships independent of

current responsibilities)

From-To Title Organization name

2021-2022 MEMBER CLUBS EMTREPRENARIANT
2021-2022 MEMBER CLUBS INTELLEC-ART
2021-2022 MEMBER CLUB TOAST MATER

V. Previous Experience in the United States. Have you travelled to the U.S. before? YES or No
If yes, please specify below.

From-To Purpose(s)

W. Family/Friends residing in the United States: Do your Family Members reside in the U.S?: Yes
or No If yes, please specify below.

Family member’s Name Relationship City and State in the U.S.

X. Evidence of English Fluency: Please comment on your English level.

I HAVE AN INTERMEDIATE LEVEL , I HAVE GOT DIFFICULTIES SPEAKING, LISTENING
Y. Personal Essay ( 500 words limit)
Tell us about yourself and your goals. Please structure your essay in paragraphs and limit
your response to 500 words, or approximately one page, single spaced. In your statement,
please address the following questions:
· What about your background and/or interests makes you competitive for the SUSI
exchange program?
· What will you contribute to the program?
· How do you expect your participation in the SUSI Exchange program affect your
community or, region/country?

Please send your filled form at: bamakoscholarships@state.gov

· How will the SUSI exchange affect you personally or professionall

Please send your filled form at: bamakoscholarships@state.gov