APPLICANT

First Name: Sex: Home Address Facebook ID Birth Date: Nick Name: Last Name: Birth Place: E-mail: Skype ID / Other ID Pirtskhalaishvili Citizensh ip

EDUCATION
Language Proficiency
Write language name and then circle or fill color in options

S S S S

R R R R

W W W W

F F F F

H H H H

S (Speak) R (Read) W (Write) F (First Language) H (Spoken at Home)

General Education
Indicate your School Name, Grade and Year orCif you currently study there

School Name: From (MM/YYYY/GG) School Name: From (MM/YYYY/GG) School Name: From (MM/YYYY/GG)

To To

(MM/YYYY/GG) or (C) (MM/YYYY/GG) or (C)

To (MM/YYYY/GG) or (C) Graduation Date

University Education
Indicate your University / College Name, Faculty and Degree and Dates attended orCif you currently study there

University / College Name: Faculty Name: Fro (MM/YYYY) m: University / College Name: Faculty Name: Fro (MM/YYYY) m:

Degre e: T o

Bachelor / Master / Phd

(MM/YYYY) or (C)

Degre e: T o

Bachelor / Master / Phd

(MM/YYYY) or (C)

Other Courses
Center Name: Course Name: Fro (MM/YYYY) m: Center Name: Course Name: Fro (MM/YYYY) m: Center Name: Course Name: Fro (MM/YYYY) m:

Proof: T o

Bachelor / Master / Phd

(MM/YYYY) or (C)

Proof: T o

Bachelor / Master / Phd

(MM/YYYY) or (C)

Proof: T o

Bachelor / Master / Phd

(MM/YYYY) or (C)

EXPERIENCE

Extracurricular Activities
Activit y: Position Held: Activit y: Position Held: Activit y: Position Held: Activit y: Position Held: Approx. Time Spent:

# Day / Wk. / Yr.

Approx. Time Spent:

# Day / Wk. / Yr.

Approx. Time Spent:

# Day / Wk. / Yr.

Approx. Time Spent:

# Day / Wk. / Yr.

Work Experience
Company/Organiz ation: Positio n: Company/Organiz ation: Positio n: Company/Organiz ation: Positio n: Company/Organiz ation: Positio n:

From

MM/YYYY

To

MM/YYYY

From

MM/YYYY

To

MM/YYYY

From

MM/YYYY

To

MM/YYYY

From

MM/YYYY

To

MM/YYYY

ACHIEVEMENTS & HONORS

PERSONAL
Religion (Optional)
Academic Interests: Career Interests: Hobbies Phobias

Do you smoke? (Optional)

2 favorite colors: 3 Words which describe you 3 Words which absolutely NOT describe you

Are you Experienced with working with a club or group, and what was your role in most cases?

How tolerant person are you?

Are you last minute kind of person? If yes, give some example briefly

How do you imagine, what is fx club for you?

Why this club and what do you expect from fx?

Please write an essay of 150-300 words on a topic of your choice:

1. Indicate a person who has had a significant influence on you, and describe that influence. 2. Describe a character in fiction, a historical figure or creative work (art, music, science) that has had an influence on you and explain that influence. 3. Topic of your choice. (Free Essay) Ready? Go!

Title Here