Application Form:

Please send your application by e-mail to Public Diplomacy Section at KosovoBenFranklin@state.gov by

February 20, 2022 at 23:59.

Only applications submitted to this e-mail address will be considered.

1. Last (family) name as on Passport:

2. First name as on Passport:
3. Middle name(s) as on Passport:
4. Date of birth (month/day/year):
5. City of birth:
6. Country of birth:
7. Country of residence:
8. Country of citizenship:
9. Gender:
10. Occupation:
11. Home full address:
12. Telephone number:
13. E-mail address (es):
14. Medical, physical, dietary, or other personal considerations (at this time, no physical examination is required to
participate in the program although the U.S. host institution may have specific requirements):
15. Name of the high school or college/university:
16. Field of study (if applicable):
17. Any other relevant educational, academic and professional experience or training:
18. Active memberships, special interests, or extracurricular activities:
19. Previous travel and study experience in the United States. Please include dates and indicate whether such travel was
supported by U.S. government funds:
20. Evidence of competence in written and oral English (e.g., personal interview, test score, teacher recommendations etc.):
21. Future study or career plans:
22. Personal statement (not to exceed 250 words): please describe your interest in the Institute. Why are you an ideal
candidate and how will your participation benefit your community?

23. Personal statement (not to exceed 250 words): please describe one community or civic activity that you’ve been involved
in, including an account of your personal contribution to the activity.

24. Attach two teacher recommendations regarding your Academic Achievements and Passport Copy!