APPLICATION

1. NAME (as written on official documents):____________________________________________

(Family Name) (First Name) (Middle)
. !ummer Institute: En"ironmental !tewards#i$
%. CO&NT'( O) CITI*EN!+IP: ROMANIA
,. CO&NT'( O) LE-AL 'E!I.ENCE:

/. PLACE O) 0I'T+:

(City or Town) (Country)
1. .ATE O) 0I'T+:

(Month) (Day) (Year)
2. Male: )emale:
3. C&''ENT +OME A..'E!!:
treet!"uildin# Num$er: A%artment:

City: &ostal Inde':

Country:
Tele%hone: (mail: _________________________________________
)
41, !&MME' IN!TIT&TE! )O'
E&'OPEAN !T&.ENT LEA.E'!
A P'O-'AM O) T+E 0&'EA& O) E.&CATIONAL AN. C&LT&'AL A))AI'!5
&.!. .EPA'TMENT O) !TATE

Name:666666666666666666666666666666
41, !ummer Institutes for Euro$ean !tudent Leaders
Mo$ile :___________________________
7. PE'MANENT +OME A..'E!!:
treet!"uildin# Num$er: A%artment:

City: &ostal Inde':

Country:
14. NAME O) C&''ENT ACA.EMIC IN!TIT&TION: ______
FAC*+TY!D(&ARTM(NT:
Address:

City: &ostal Inde':

Country: Tele%hone: ______________________
11. P'E!ENT !T&.( P'O-'AM: First Year e,ond Year Other__________________
1. E8PECTE. -'A.&ATION .ATE (mont#9:ear):
1%. C&''ENT !PECIALI*ATION 9 )IEL. of !T&.(: 6666
1,. +a"e :ou e"er tra"eled outside of 'omania; Yes No
I- yes. %lease list all ,ountries:
_______________________________________________________________________________
1/. +a"e :ou e"er tra"eled to t#e &nited !tates; (es No
I- you ha/e tra/eled to the *nited tates. what was the %ur%ose o- your /isit0
6666666666666666666666666666666666666666666666666666666666666666666666666666666
11. EN-LI!+ LAN-&A-E P'O)ICIENC(: I- you are sele,ted as a %arti,i%ant and (n#lish is
not your nati/e lan#ua#e. you will $e as1ed to ta1e an (n#lish lan#ua#e assessment at the start o-
the summer %ro#ram2 I- you ha/e %re/iously ta1en an o--i,ial (n#lish lan#ua#e e'am. su,h as the
TO(F+. %lease list the name o- the e'am. your s,ore and the date and %la,e where you too1 the
e'amination2
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Name:666666666666666666666666666666
41, !ummer Institutes for Euro$ean !tudent Leaders
66666 !core: 66666666666666 .ate: 66666666666666Location: 6666666666666
12. Please ran= :our En>lis# lan>ua>e $roficienc: in t#e followin> areas:
%ea1in#: Fair 4ood (',ellent
Readin#: Fair 4ood (',ellent
5ritin#: Fair 4ood (',ellent
13. Please descri?e an: $re@e<istin> medical conditions or ot#er dietar: and $ersonal
consideration. The in-ormation you %ro/ide will not a--e,t your sele,tion in the %ro#ram. $ut will
ena$le the host institution to ma1e any ne,essary a,,ommodations2
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
17. E8T'A@C&''IC&LA ACTIAITIE!: &lease list all /olunteer %ositions. wor1 e'%erien,e.
awards. and leadershi% %ositions you ha/e held within the %ast -our years2
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6666666666666666666666666666666666666666666666666666666666666666666666666666666
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41, !ummer Institutes for Euro$ean !tudent Leaders
e se%arate short essays o- no more than 788 words addressin# the -ollowin# 9uestions2
A. 5hy are you interested in %arti,i%atin# in this %ro#ram0 5hat do you ho%e to learn0
0. *sin# one or more e'am%les. %lease des,ri$e a ,hallen#e at s,hool. wor1. or in your %ersonal
li-e that you ha/e had to o/er,ome2 :ow did you resol/e the situation0
C. &arti,i%ants in the ummer Institutes use their summer e'%erien,es to #i/e $a,1 to their
,ommunities2 In what ways ,an you ima#ine #i/in# $a,1 to your ,ommunity a-ter you
%arti,i%ate in the ummer Institute0
1. .ATA INB&I'(: :ow did you hear a$out this %ro#ram0
Ful$ri#ht Commission Friend Other: _________________
PLEA!E 'EMEM0E' TO !&0MIT (O&' APPLICATION5 E!!A(!5 T'AN!C'IPT!5
AN. 'E)E'ENCE! 0( Marc# 115 41, .
;
!ummer Institutes for Euro$ean !tudent Leaders
A $ro>ram of t#e 0ureau of Educational and Cultural Affairs5
&.!. .e$artment of !tate
'E)E'ENCE )O'M
(TO 0E COMPLETE. 0( APPLICANT):
Name o- A%%li,ant__________________________________________________________________
Country___________________________________________________________________________
Name o- (/aluator!Re-eren,e__________________________________________________________
Title o- (/aluator___________________________________________________________________
5or1 Institution____________________________________________________________________
5or1 Address o- (/aluator___________________________________________________________
5or1 Tele%hone o- (/aluator Fa'____________ (<mail
This re-eren,e -orm may $e ,om%leted $y a su%er/isor at wor1. a %ro-essor!a,ademi, ad/isor!dean. or a
,ommunity leader who 1nows the a%%li,ant well and is -amiliar with the a%%li,ant=s a,ademi, and!or
%ro-essional wor12 'elati"es and friends of t#e a$$licant ma: not com$lete t#is recommendation form.
This -orm should $e ty%ewritten in (n#lish. i- %ossi$le2 All re,ommendations must $e si#ned at the $ottom. $ut
.O NOT re9uire a stam%2 Please return t#e com$leted reference form to t#e a$$licant to $e su$mitted with
the ,om%leted a%%li,ation2 &lease .O NOT send re-eren,e -orms dire,tly to the Ful$ri#ht Commission2 The
two re-eren,e -orms must $e ,om%leted $y two di--erent indi/iduals2
(TO 0E COMPLETE. 0( EAAL&ATO'):
1 :ow lon# ha/e you 1nown the a%%li,ant0
In what ,a%a,ity ha/e you 1nown the a%%li,ant0 Che,1 all that a%%ly2
Tea,her!&ro-essor >o$ u%er/isor A,ademi, Ad/isor
Other (%lease s%e,i-y)
% &lease e/aluate the a%%li,ant as ,om%ared to other students in terms o- the ,hara,teristi,s $elow:
(',ellent 4ood Fair &oor *na$le to >ud#e
+eadershi% &otential
Cross<,ultural Interests
Initiati/e and &ro$lem ol/in# 1ills
Creati/e and Inde%endent Thin1in#
Ada%ta$ility
Inter%ersonal 1ills
Res%e,t -or Others!Res%onsi$ility
Interest in Community er/i,e
)8
!ummer Institutes for Euro$ean !tudent Leaders
A $ro>ram of t#e 0ureau of Educational and Cultural Affairs5
&.!. .e$artment of !tate
'E)E'ENCE )O'M
Maturity
, &lease ,hoose one o- the -ollowin#:
?Re,ommend with ,on-iden,e
?Re,ommend with reser/ation
?Do not re,ommend
/? EAAL&ATION
&lease su$mit short statements in the s%a,e %ro/ided. #i/in# a ,andid e/aluation o- the a%%li,ant=s %ast
a,ademi, and!or wor1 %er-orman,e2 Your statements will $e #i/en ,are-ul ,onsideration $y the sele,tion
%anel re/iewin# this a%%li,ation2 There-ore. your ,omments should $e as ,om%lete and detailed as
%ossi$le (atta,h additional %a#es i- ne,essary)2
1. A$$licantCs a?ilit: to e<$ress #is9#er ideas clearl: ?ot# in writin> and "er?all:.




. A$$licantCs a?ilit: to interact well wit# ot#er students and $rofessors.




%. A$$licantCs stren>t#s and wea=nesses as a $otential e<c#an>e student.



!ummer Institutes for Euro$ean !tudent Leaders
A $ro>ram of t#e 0ureau of Educational and Cultural Affairs5
&.!. .e$artment of !tate
'E)E'ENCE )O'M

,. A$$licantCs outstandin> or distin>uis#in> talents and c#aracteristics.




/. A$$licantCs $otential to si>nificantl: contri?ute to t#e $u?lic sector in #is9#er #ome communit:.




I here$y ,on-irm that the answers on this -orm are my own and re%resent my %ro-essional o%inion o- the
a%%li,ant2

i#nature o- (/aluator Date
!ummer Institutes for Euro$ean !tudent Leaders
A $ro>ram of t#e 0ureau of Educational and Cultural Affairs5
&.!. .e$artment of !tate
'E)E'ENCE )O'M
(TO 0E COMPLETE. 0( APPLICANT):
Name o- A%%li,ant__________________________________________________________________
Country___________________________________________________________________________
Name o- (/aluator!Re-eren,e__________________________________________________________
Title o- (/aluator___________________________________________________________________
5or1 Institution____________________________________________________________________
5or1 Address o- (/aluator___________________________________________________________
5or1 Tele%hone o- (/aluator Fa'____________ (<mail
This re-eren,e -orm may $e ,om%leted $y a su%er/isor at wor1. a %ro-essor!a,ademi, ad/isor!dean. or a
,ommunity leader who 1nows the a%%li,ant well and is -amiliar with the a%%li,ant=s a,ademi, and!or
%ro-essional wor12 'elati"es and friends of t#e a$$licant ma: not com$lete t#is recommendation form.
This -orm should $e ty%ewritten in (n#lish. i- %ossi$le2 All re,ommendations must $e si#ned at the $ottom. $ut
.O NOT re9uire a stam%2 Please return t#e com$leted reference form to t#e a$$licant to $e su$mitted with
the ,om%leted a%%li,ation2 &lease .O NOT send re-eren,e -orms dire,tly to the Ful$ri#ht Commission2 The
two re-eren,e -orms must $e ,om%leted $y two di--erent indi/iduals2
(TO 0E COMPLETE. 0( EAAL&ATO'):
1 :ow lon# ha/e you 1nown the a%%li,ant0
In what ,a%a,ity ha/e you 1nown the a%%li,ant0 Che,1 all that a%%ly2
Tea,her!&ro-essor >o$ u%er/isor A,ademi, Ad/isor
Other (%lease s%e,i-y)
% &lease e/aluate the a%%li,ant as ,om%ared to other students in terms o- the ,hara,teristi,s $elow:
(',ellent 4ood Fair &oor *na$le to >ud#e
+eadershi% &otential
Cross<,ultural Interests
Initiati/e and &ro$lem ol/in# 1ills
Creati/e and Inde%endent Thin1in#
Ada%ta$ility
Inter%ersonal 1ills
Res%e,t -or Others!Res%onsi$ility
Interest in Community er/i,e
!ummer Institutes for Euro$ean !tudent Leaders
A $ro>ram of t#e 0ureau of Educational and Cultural Affairs5
&.!. .e$artment of !tate
'E)E'ENCE )O'M
Maturity
, &lease ,hoose one o- the -ollowin#:
?Re,ommend with ,on-iden,e
?Re,ommend with reser/ation
?Do not re,ommend
/? EAAL&ATION
&lease su$mit short statements in the s%a,e %ro/ided. #i/in# a ,andid e/aluation o- the a%%li,ant=s %ast
a,ademi, and!or wor1 %er-orman,e2 Your statements will $e #i/en ,are-ul ,onsideration $y the sele,tion
%anel re/iewin# this a%%li,ation2 There-ore. your ,omments should $e as ,om%lete and detailed as
%ossi$le (atta,h additional %a#es i- ne,essary)2
1. A$$licantCs a?ilit: to e<$ress #is9#er ideas clearl: ?ot# in writin> and "er?all:.




. A$$licantCs a?ilit: to interact well wit# ot#er students and $rofessors.




%. A$$licantCs stren>t#s and wea=nesses as a $otential e<c#an>e student.



!ummer Institutes for Euro$ean !tudent Leaders
A $ro>ram of t#e 0ureau of Educational and Cultural Affairs5
&.!. .e$artment of !tate
'E)E'ENCE )O'M

,. A$$licantCs outstandin> or distin>uis#in> talents and c#aracteristics.




/. A$$licantCs $otential to si>nificantl: contri?ute to t#e $u?lic sector in #is9#er #ome communit:.




I here$y ,on-irm that the answers on this -orm are my own and re%resent my %ro-essional o%inion o- the
a%%li,ant2

i#nature o- (/aluator Date