HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

APPLICATION FOR ADMISSION TO THE HUBERT H. HUMPHREY FELLOWSHIP PROGRAM- 2014-2015 FOR MID-CAREER PROFESSIONAL DEVELOPMENT IN THE UNITED STATES
Information and Application Instructions
PROGRAM DESCRIPTION: The Humphrey Fellowship Program provides mid-career professionals from designated countries of Africa, Asia, Latin America, the Caribbean, the Middle East, Europe and Eurasia with an opportunity to enhance their professional capabilities through participation in specialized, 10-month, non degree programs developed specifically for small clusters of Humphrey Fellows at selected U.S. universities. The Humphrey Program was initiated in 1978 to honor the memory and accomplishments of the late Senator and Vice President, Hubert H. Humphrey. Fellows are selected based on their potential for national leadership and commitment to public service, in either the public or private sector. The program provides a basis for establishing long-lasting productive partnerships and relationships between citizens of the United States and their professional counterparts in other countries, fostering an exchange of knowledge and mutual understanding throughout the world. Funding for the Humphrey Program is provided by the U.S. government through the United States Department of State and other co-sponsors. The Institute of International Education (IIE) collaborates with the State Department's Bureau of Educational and Cultural Affairs in administering the program. The types of university programs arranged for Humphrey Fellows depart from a traditional discipline-oriented focus and have a problem-solving and experience-sharing emphasis. The programs are not degree-related or aimed at providing scholarly preparation or basic training in a field. The objective is to provide Humphrey Fellows with an overall experience that broadens their perspectives, enhances their capability to assume greater career responsibilities, and provides opportunities to establish useful professional contacts. To accomplish these objectives, programs are designed to include various combinations of course work, independent projects, internships, consultations with U.S. faculty or experts, field trips, and special seminars. Under the guidance of a designated faculty advisor or coordinator, Fellows plan programs that best suit their individual career development needs. DURATION OF GRANT: The program arranged for Humphrey Fellows extends from August or early September to the following June. Applicants who need additional English training may be required to arrive in the United States as early as April for intensive language study before beginning their regular university program. Candidates must be able to participate in the full period of the English and/or university programs. NONDEGREE STATUS: The program designed for Humphrey Fellows does not result in the awarding of a degree. While Fellows are able to enroll in courses relevant to their professional interests, the Humphrey Program is not appropriate for those who wish to concentrate on academic work required for a U.S. degree. Humphrey Fellows spend a considerable portion of their time engaged in off-campus activities such as internships, field trips, workshops, and special projects that give them practical experience in their professional fields. Fellows who successfully complete the program are awarded a Certificate of Participation. FINANCIAL PROVISIONS: The Humphrey Fellowship provides a monthly maintenance allowance, a book and supplies allowance, tuition and fees when applicable, round-trip international travel to the host institution (and to the Fellows Englishlanguage training program when applicable) and domestic travel to Washington, D.C. for a special seminar. Supplementary funds are provided for professional activities such as field trips or attendance at conferences. Humphrey Fellowships are not renewable. Humphrey Fellows should plan to bring with them some personal funds to cover incidental expenses not covered in the grant. Humphrey Fellowships do not include funds for dependents (family members). Humphrey Fellows are responsible for providing travel, insurance, and financial support for any dependents accompanying them in the United States. Please note that English and orientation centers cannot accommodate dependents. Therefore, dependents should not arrive in the United States until the Fellows are settled in their academic year programs and have secured housing (at least 30 days after the Fellows arrival) at the host campus.

HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

PROGRAM FIELDS: The programs arranged for Humphrey Fellows are related to one of the following fields: agricultural development/agricultural economics; communications/journalism; economic development/finance and banking; educational administration, planning and policy; HIV/AIDS policy and prevention; human resource management; law and human rights; natural resources and environmental management; public health policy and management; public policy analysis and public administration; substance abuse education, treatment and prevention; teaching of English as a foreign language; technology policy and management; trafficking in persons, policy and prevention; urban and regional planning. The university programs do not address themselves to the scientific or technical aspects of these fields, but rather to broad policy-making and problemsolving issues. PLACEMENT IN UNIVERSITY PROGRAMS: Candidates who are selected for fellowships are placed in clusters by field of interest at U.S. universities specially designated to host a group of Humphrey Fellows. IIE, therefore, is not able to make placements at specific universities requested by candidates, or to award fellowships enabling candidates to attend a U.S. university on the basis that they have already been admitted. Candidates should not apply directly to U.S. institutions. APPLICATION INSTRUCTIONS: 1. Each page of the enclosed application carries its own instructions and should be read carefully before proceeding. All forms must be completed in English and typewritten or computer-generated. Please answer every question as completely as possible (except for the Substance Abuse form, page 5A of the application, which should only be completed by candidates in the field of substance abuse). 2. Please take special notice of #13, "Give a 50-word summary of your proposed program plan." This section is very important as members of the J. William Fulbright Scholarship Board read this summary and determine whether to approve Humphrey nominations. Please be sure to provide a succinct but substantive summary statement. 3. The completed application must be returned to the office or nomination committee in your home country according to the instructions provided by them. (Do not submit the application to IIE.) 4. You must attach complete and certified academic documents covering your entire period of study at universities or other postsecondary institutions, including advanced degrees. Documents must be accompanied by complete English translations. Your academic documents must consist of: A certified official record (transcript) from each university or other postsecondary institution, listing the subjects you studied and the grades (marks) you received during each year of your enrollment. Include all postsecondary institutions you attended, even those from which you did not receive a degree or diploma. Certified, official evidence of each postsecondary or university degree, diploma, or certificate awarded to you. To be considered official, each academic document must bear the seal of the issuing institution as well as the signature of its officials. Copies of original documents will be accepted only if they are separately certified as being authentic duplicates of originals. Certification of copies may be made by the issuing institution, by your selection committee, or by a U.S. consular official. 5. You are required to submit two letters of reference, one of which must be from your immediate supervisor in your current position. The letters of reference should be written in English or should include an English translation. 6. Important information about TOEFL: The Test of English as a Foreign Language (TOEFL) is required by all U.S. universities. Absence of TOEFL scores could jeopardize your chance of obtaining a Fellowship. After passing a preliminary English test, you must register for TOEFL immediately and take it as early as possible and no later than November 2012. For information and/or test registration forms, contact the Binational Education/Fulbright Commission or U.S. Embassy in your home country. You must indicate that you want your score reports sent to Institute of International Education (Hubert H. Humphrey Fellowship Program) Code Number 9616. You must be sure to indicate this code (9616) on the registration forms or on the answer sheets provided at the time you take the examination. TOEFL vouchers will be given to finalists by the Binational Commission or U.S. Embassy. As soon as you receive your TOEFL score, please present it to the Binational Commission or U.S. Embassy. 7. As part of your application, you also must have a formal English language interview and submit the enclosed English Language Report Form (page 7 of the application).

HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

Bio-Sheet A
1. NAME OF APPLICANT (Exactly as on your passport/ travel docu ents! " #. $E%" Fe ale Male

Mr.
(Title)

(First name)

(Middle name)

(Last name)

&. PLACE OF 'I(T) (c*ty or to+n, country!" 4. .ATE OF 'I(T) Mont/ .ay 5ear 3

-. PE(MANENT A..(E$$ OF APPLICANT"

Telep/one nu 0er (*nclude country 1 c*ty codes!" )o e" 2or3" Fax" E a*l"

6. CO7NT(5 OF P(E$ENT CITI8EN$)IP"

9. PO$TAL A..(E$$ OF APPLICANT (I: sa e as a0ove, +r*te ;sa e<!

=. CO7NT(5 OF P(E$ENT (E$I.ENCE"

>. IN.ICATE 5EA( 1 CO7NT(5 OF AN5 P(E?IO7$ F7L'(I@)T @(ANT$"

1A. E.7CATION" L*st all o!t-!e"o#$%&' educat*onal *nst*tut*ons attended, 0eB*nn*nB +*t/ t/e ost recent, *nclud*nB any *n +/*c/ you are currently enrolled. Cop*es o: d*plo as, acade *c transcr*pts, cert*:*cates, and EnBl*s/ translat*ons s/ould 0e attac/ed. (To add ore *n:or at*on, please add ro+s or copy ta0le onto an add*t*onal s/eet.! Na e o: *nst*tut*on, un*vers*ty or pro:ess*onal sc/ool, and locat*on 1. -. 9. #. MaCor :*eld(s! o: study .ates attended ( ont/ and year! Fro To Actual na e o: d*plo a or deBree (do not translate! .ate rece*ved or expected

11. Na e your (o!t !i)#i*i"%#t pu0l*cat*ons//onors/a+ards/proCects/ot/er acco pl*s/ ents"

1-" @I?E A 50-WOR+ $7MMA(5 OF 5O7( P(OPO$E. PROGRAM PLAN ( ore co plete plan to 0e outl*ned on paBe 9D 0e sure t/*s su ary captures t/e essence o: your proBra plan!.

19. C7((ENT OCC7PATION" 5our Co0 t*tle" .ates o: e ploy ent ( ont/ 1 year!" Na e and address o: your place o: e ploy ent"

1#. .escr*0e your current Co0 respons*0*l*t*es"

HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

Bio-Sheet B
1&. Prev*ous pos*t*ons /eld (0eB*n +*t/ ost recent!" Eo0 T*tle .ates o: E ploy ent Fro (*n years! To Na e 1 address o: place o: e ploy ent 1. -. 9. #. &.

14. Please *nd*cate your co puter pro:*c*ency and level o: s3*ll *n +ord process*nB, spreads/eets, electron*c spec*:*c.

a*l, etc. Please 0e

16. Please *nd*cate countr*es outs*de your o+n, *nclud*nB t/e 7n*ted $tates, *n +/*c/ you /ave l*ved, traveled, or stud*ed. Please l*st dates ( ont/s/years! and reasons :or eac/ v*s*t. Please attac/ an add*t*onal s/eet *: necessary. .ates o: v*s*t (eason :or v*s*t Country v*s*ted Fro ( o/yr! To (( o/yr! 1. -. 9. #. &. 4. 1=. Persons to 0e not*:*ed *n case o: e erBency" In /o e country" Na e" Address" Telep/one" (elat*ons/*p In t/e 7n*ted $tates" Na e" Address" Telep/one" (elat*ons/*p"

I cert*:y t/at all *n:or at*on B*ven *n t/*s appl*cat*on *s co plete and accurate to t/e 0est o: y 3no+ledBe. I ac3no+ledBe t/at I /ave co pletely read and understood t/e Information and Application Instructions and I aBree to co ply +*t/ all reBulat*ons descr*0ed t/ere. I aBree to a0*de 0y t/e Pol*c*es Bovern*nB t/e select*on o: Ful0r*B/t/)u p/rey Brantees, as esta0l*s/ed 0y t/e E. 2*ll*a Ful0r*B/t Fore*Bn $c/olars/*p 'oard (F$'! (co plete pol*c*es ava*la0le at /ttp"//exc/anBes.state.Bov/educat*on/:ul0r*B/t/::s0/pol*c*es/-AA#/! +/*c/ supercede all ot/er docu ents relat*nB to y appl*cat*on :or a )u p/rey Fello+s/*p. I also aBree to return to y /o e country upon t/e exp*rat*on o: y proBra *n t/e 7n*ted $tates o: A er*ca.

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HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

P&o)&%( P,%#
Na e o: appl*cant" 1-. (1!Please descr*0e your country. Country" aCor area o: *nterest and expla*n /o+ t/*s area addresses t/e spec*:*c develop ent needs o: your

(-! .escr*0e t/e type o: )u p/rey proBra you +ould l*3e to underta3e *n order to eet t/ese c/allenBes. Ind*cate t/e 3*nds o: acade *c course +or3, *nterns/*p exper*ences, and/or pro:ess*onal tra*n*nB exper*ences you +ould l*3e to underta3e.

(9! .escr*0e /o+ t/e acHu*s*t*on o: ne+ 3no+ledBe and s3*lls +*ll ass*st you *n /elp*nB your country to ac/*eve *ts develop ent Boals.

HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

Pe&!o#%, St%te(e#t! A
Na e o: Appl*cant" Country" 2r*te a paraBrap/ ans+er*nB eac/ o: t/e :ollo+*nB t/ree Huest*ons. Please use o#,' t/e space prov*ded 20. Please descr*0e /o+ you /ave de onstrated a stronB co *t ent to pu0l*c serv*ce *n your pro:ess*onal/personal l*:e. (*.e. pro:ess*onal respons*0*l*t*es, co un*ty or c*v*c *nvolve ent, etc.!

21. Please state your pro:ess*onal Boals :or t/e next :*ve years and *nd*cate /o+ t/e tra*n*nB rece*ved under t/e )u p/rey ProBra +*ll contr*0ute to your anaBer*al s3*lls, leaders/*p a0*l*ty, and co *t ent to pu0l*c serv*ce.

HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

Pe&!o#%, St%te(e#t! B
Na e o: Appl*cant" Country" 22. .escr*0e a pro0le or c/allenB*nB s*tuat*on t/at you /ave resolved 0y us*nB your *n*t*at*ve. 2/at +as t/e outco eI Please select t/*s exa ple care:ully. It s/ould *llustrate so et/*nB t/at you +ant t/e rev*e+ panel to 3no+ a0out your pro0le Jsolv*nB, leaders/*p a0*l*t*es, or co *t ent to pu0l*c serv*ce.

HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

S/0!t%#"e A0/!e Fie,$ o* St/$'

NOTE1 THIS PAGE SHOUL+ BE FILLE+ OUT ONLY BY THOSE APPLICANTS WHOSE PROPOSE+ FIEL+ OF STU+Y IS SUBSTANCE ABUSE Please contact t/e 7.$. E 0assy or t/e '*nat*onal Educat*onal Co *ss*on *n your country 0e:ore co plet*nB t/e :ollo+*nB" (5our co ents s/ould 0e cont*nued on a separate s/eet *: ore space *s needed.! 1. 'r*e:ly descr*0e +/at you 3no+ a0out current su0stance a0use pro0le s *n your country.

-. 'r*e:ly descr*0e recent su0stance a0use researc/ proCect(s! *n +/*c/ you /ave 0een enBaBed, t/e extent o: your role *n t/ese proCect(s!, and l*st any pu0l*cat*ons *n connect*on +*t/ researc/ +or3 t/at you /ave done.

9. 'r*e:ly descr*0e an area o: su0stance a0use researc/ t/at you +ould l*3e to pursue 0ased on t/e needs *n your country.

HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

Pe&!o#%, I#*o&(%tio#
I. PERSONAL FINANCIAL INFORMATION (Indicate all funds in your local currency.) 1. 5our annual salary Inco e per year :ro ot/er sources" 5es No

-. 2*ll your salary 0e cont*nued dur*nB your stay *n t/e 7.$.I I: yes +/at percentaBeI

II. +EPEN+ENTS1 The H/0e&t H. H/( h&e' Fe,,o2!hi P&o)&%( $oe! #ot &o3i$e %,,o2%#"e! *o& $e e#$e#t!. I: your dependents acco pany you, you +*ll 0e respons*0le :or prov*d*nB all travel, adeHuate ed*cal *nsurance, and support :or t/e . E#),i!h4O&ie#t%tio# Ce#te&! "%##ot %""o((o$%te $e e#$e#t!. .ependents ay not arr*ve unt*l you are settled *n your acade *c proBra and /ave :ound /ous*nB (at least 9A days a:ter your arr*val at acade *c place ent!. 1. Mar*tal status you dur*nB your acade *c year *n t/e

-. L*st t/e relat*ons/*ps and aBes o: any persons +/o +*ll reHu*re :*nanc*al ass*stance :ro 7.$." 1. -. 9. 2*ll any dependents acco pany you to t/e 7.$.I 9. #. 5es

No

I: yes, B*ve na e(s! as s/o+n on passport(s!, Bender, relat*ons/*p(s!, date(s! o: 0*rt/, c*ty/country o: 0*rt/ and c*t*Kens/*p :or eac/ dependent. Please also state /o+ you *ntend to prov*de :or t/e dur*nB your year o: study *n t/e 7.$. III. ACA+EMIC PROGRAM 1. I: reHu*red, +*ll you 0e a0le to arr*ve :or EnBl*s/ lanBuaBe tra*n*nB as early as Apr*l, May, Eune or EulyI -. 2*ll you 0e a0le to o0ta*n a leave o: a0sence :ro your current pos*t*on :or a per*od o: 11 ont/s, or up to 1# ont/s *: you reHu*re EnBl*s/ tra*n*nBI 9. 2/en +*ll you ta3e a standard*Ked test t/at assessed your EnBl*s/ lanBuaBe a0*l*ty, suc/ as TOEFLI I: you /ave not sc/eduled t/*s test 0e:ore Nove 0er 1, -AA=, you E 0assy *n your /o e country i((e$i%te,'. 5es No

5es

No

ust not*:y t/e '*nat*onal Educat*onal Co *ss*on or 7.$.

IMPORTANT 1. An official TOEFL score (no more than two years old) is required for all countries e cept the En!lish spea"in! #ari$$ean. %. &ou must indicate that you want your TOEFL score reports sent to' Institute of International Education ((u$ert (umphrey Fellowship )ro!ram) #ode *um$er 9616. &ou must $e sure to indicate this code (+,1,) on the re!istration forms or on the answer sheets pro-ided at the time you ta"e the e amination. .. As soon as you recei-e your TOEFL score/ report it to the 0inational Educational #ommission or 1.2. Em$assy. 3. )lease si!n $elow as authori4ation for IIE to recei-e your TOEFL score. I /ere0y aut/or*Ke t/e Inst*tute o: Internat*onal Educat*on to rece*ve .ate" FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF y TOEFL score report.

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HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

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PROGRAM +ESCRIPTION

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T/e )u p/rey Fello+s/*p ProBra prov*des *dJcareer pro:ess*onals :ro des*Bnated countr*es o: A:r*ca, As*a, Lat*n A er*ca, t/e Car*00ean, t/e M*ddle East, and Euras*a +*t/ an opportun*ty to en/ance t/e*r pro:ess*onal capa0*l*t*es t/rouB/ part*c*pat*on *n spec*al*Ked 1AJ ont/ proBra s developed spec*:*cally :or s all clusters o: )u p/rey Fello+s at selected 7.$. un*vers*t*es. Pr* ary :und*nB :or t/e )u p/rey ProBra *s prov*ded 0y t/e 7.$. Bovern ent t/rouB/ t/e 7n*ted $tates .epart ent o: $tate. T/e Inst*tute o: Internat*onal Educat*on (IIE! ad *n*sters t/e proBra on 0e/al: o: t/e $tate .epart ent. T/e types o: un*vers*ty proBra s arranBed :or )u p/rey Fello+s depart :ro a trad*t*onal d*sc*pl*neJor*ented :ocus and /ave a pro0le Jsolv*nB and exper*enceJs/ar*nB e p/as*s. T/e proBra s are not deBreeJrelated and not a* ed at prov*d*nB sc/olarly preparat*on or 0as*c tra*n*nB *n a :*eld. T/e o0Cect*ve *s to prov*de )u p/rey Fello+s +*t/ an overall exper*ence t/at 0roadens t/e*r perspect*ves, en/ances t/e*r capa0*l*ty to assu e Breater career respons*0*l*t*es, and prov*des opportun*t*es to esta0l*s/ use:ul pro:ess*onal contacts. To acco pl*s/ t/ese o0Cect*ves, proBra s are des*Bned to *nclude var*ous co 0*nat*ons o: course +or3, *ndependent proCects, *nterns/*ps, consultat*ons +*t/ 7.$. :aculty or experts, :*eld tr*ps, and se *nars. 7nder t/e Bu*dance o: a des*Bnated :aculty adv*sor or Lcoord*nator,L Fello+s plan proBra s t/at 0est su*t t/e*r *nd*v*dual career develop ent needs. I. In t/e rat*nB c/art 0elo+, please evaluate t/e appl*cant *n co par*son +*t/ ot/er pro:ess*onals +/o your career. E9"e,,e#t :e&' Goo$ you /ave 3no+n dur*nB

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Intellectual A0*l*ty Gno+ledBe o: F*eld 2or3 )a0*ts $er*ousness o: Purpose Co *t ent to Nat*onal .evelop ent

(esource:ulness and In*t*at*ve E ot*onal Matur*ty Adapta0*l*ty to Ne+ $*tuat*ons Leaders/*p Mual*t*es

10

HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

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II. Please assess t/e cand*dateNs su*ta0*l*ty :or t/e )u0ert ). )u p/rey Fello+s/*p ProBra 0ased on /*s//er educat*onal 0ac3Bround, +or3 exper*ence and *nd*v*dual needs :or career develop ent. (A descr*pt*on o: t/e )u p/rey ProBra *s on t/e :ront o: t/*s paBe.! Include a cand*d evaluat*on o: t/e appl*cantNs a0*l*ty to pursue ser*ous acade *c +or3 *n t/e context o: a *dJ career pro:ess*onal proBra . Ind*cate also /o+ t/*s proBra +*ll d*rectly 0ene:*t not only t/e cand*dateNs career 0ut /*s//er country and soc*ety. Also d*scuss t/e cand*dateNs leaders/*p potent*al and co *t ent to pu0l*c serv*ce. (5our co ents s/ould 0e cont*nued on a separate s/eet *: ore space *s needed.!

P,e%!e &et/&# $i&e"t,' to the Se,e"tio# Co((ittee i# the % ,i"%#t5! "o/#t&' o& to the C/,t/&%, A**%i&! O**i"e& o* the U.S. $i ,o(%ti" (i!!io# i# the % ,i"%#t5! "o/#t&'. U#$e& #o "i&"/(!t%#"e! !ho/,$ thi! ,ette& o* &e*e&e#"e 0e &et/&#e$ to the % ,i"%#t. NOTE1 IIE "%##ot )/%&%#tee thi! ,ette&5! "o#*i$e#ti%,it' o#"e it 0e"o(e! %&t o* % /#i3e&!it'5! &e"o&$!.

11

HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

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Thi! ,ette& o* &e*e&e#"e (/!t 0e 2&itte# 0' % &o*e!!o&= &o*e!!io#%, (e#to&= o& othe& %!!o"i%te o/t!i$e the "%#$i$%te5! "/&&e#t 2o&7 !etti#). Pe&!o#%, *&ie#$! o& *%(i,' (e(0e&! %&e NOT %""e t%0,e &e*e&e#"e!. I: t/*s letter *s not +r*tten *n EnBl*s/, an accurate translat*on ust 0e attac/ed.

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PROGRAM +ESCRIPTION

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I# 2h%t "% %"it' h%3e 'o/ 7#o2# the % ,i"%#t8 Si)#%t/&e (*n *n3!1

T/e )u p/rey Fello+s/*p ProBra prov*des *dJcareer pro:ess*onals :ro des*Bnated countr*es o: A:r*ca, As*a, Lat*n A er*ca, t/e Car*00ean, t/e M*ddle East, and Euras*a +*t/ an opportun*ty to en/ance t/e*r pro:ess*onal capa0*l*t*es t/rouB/ part*c*pat*on *n spec*al*Ked 1AJ ont/ proBra s developed spec*:*cally :or s all clusters o: )u p/rey Fello+s at selected 7.$. un*vers*t*es. Pr* ary :und*nB :or t/e )u p/rey ProBra *s prov*ded 0y t/e 7.$. Bovern ent t/rouB/ t/e 7n*ted $tates .epart ent o: $tate. T/e Inst*tute o: Internat*onal Educat*on (IIE! ad *n*sters t/e proBra on 0e/al: o: t/e $tate .epart ent. T/e types o: un*vers*ty proBra s arranBed :or )u p/rey Fello+s depart :ro a trad*t*onal d*sc*pl*neJor*ented :ocus and /ave a pro0le Jsolv*nB and exper*enceJs/ar*nB e p/as*s. T/e proBra s are not deBreeJrelated and not a* ed at prov*d*nB sc/olarly preparat*on or 0as*c tra*n*nB *n a :*eld. T/e o0Cect*ve *s to prov*de )u p/rey Fello+s +*t/ an overall exper*ence t/at 0roadens t/e*r perspect*ves, en/ances t/e*r capa0*l*ty to assu e Breater career respons*0*l*t*es, and prov*des opportun*t*es to esta0l*s/ use:ul pro:ess*onal contacts. To acco pl*s/ t/ese o0Cect*ves, proBra s are des*Bned to *nclude var*ous co 0*nat*ons o: course +or3, *ndependent proCects, *nterns/*ps, consultat*ons +*t/ 7.$. :aculty or experts, :*eld tr*ps, and se *nars. 7nder t/e Bu*dance o: a des*Bnated :aculty adv*sor or Lcoord*nator,L Fello+s plan proBra s t/at 0est su*t t/e*r *nd*v*dual career develop ent needs. I. In t/e rat*nB c/art 0elo+, please evaluate t/e appl*cant *n co par*son +*t/ ot/er pro:ess*onals +/o your career. E9"e,,e#t :e&' Goo$ you /ave 3no+n dur*nB Be,o2 A3e&%)e

A3e&%)e

Intellectual A0*l*ty Gno+ledBe o: F*eld 2or3 )a0*ts $er*ousness o: Purpose Co *t ent to Nat*onal .evelop ent

(esource:ulness and In*t*at*ve E ot*onal Matur*ty Adapta0*l*ty to Ne+ $*tuat*ons

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HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

Leaders/*p Mual*t*es

Co#*i$e#ti%, ,ette& o* &e*e&e#"e ;"o#t.<

II. Please assess t/e cand*dateNs su*ta0*l*ty :or t/e )u0ert ). )u p/rey Fello+s/*p ProBra 0ased on /*s//er educat*onal 0ac3Bround, +or3 exper*ence and *nd*v*dual needs :or career develop ent. (A descr*pt*on o: t/e )u p/rey ProBra *s on t/e :ront o: t/*s paBe.! Include a cand*d evaluat*on o: t/e appl*cantNs a0*l*ty to pursue ser*ous acade *c +or3 *n t/e context o: a *dJ career pro:ess*onal proBra . Ind*cate also /o+ t/*s proBra +*ll d*rectly 0ene:*t not only t/e cand*dateNs career 0ut /*s//er country and soc*ety. Also d*scuss t/e cand*dateNs leaders/*p potent*al and co *t ent to pu0l*c serv*ce. (5our co ents s/ould 0e cont*nued on a separate s/eet *: ore space *s needed.!

P,e%!e &et/&# $i&e"t,' to the Se,e"tio# Co((ittee i# the % ,i"%#t5! "o/#t&' o& to the C/,t/&%, A**%i&! O**i"e& o* the U.S. $i ,o(%ti" (i!!io# i# the % ,i"%#t5! "o/#t&'. U#$e& #o "i&"/(!t%#"e! !ho/,$ thi! ,ette& o* &e*e&e#"e 0e &et/&#e$ to the % ,i"%#t. NOTE1 IIE "%##ot )/%&%#tee thi! ,ette&5! "o#*i$e#ti%,it' o#"e it 0e"o(e! %&t o* % /#i3e&!it'5! &e"o&$!.

13

HUMPHREY FELLOWSHIP PROGRAM APPLICATION- 2014-2015

,i"%#t Che"7,i!t

PLEA$E $A?E T)I$ FO(M AN. (EFE( TO IT IN $7'MITTIN@ 5O7( APPLICATIONO

APPLICANT CHEC>LIST FOR SUBMISSION OF APPLICATION

Co pleted Appl*cat*on (For s 1J-J9J#J&J4! O::*c*al transcr*pts and d*plo as +*t/ translat*ons *: necessary 1st Letter o: (e:erence (For s = and =A! $u0stance A0use F*eld o: $tudy :or .ate o: TOEFL exa *: appl*ca0le (For &A!

14