2011 U.S.-Egypt Science Year Summer Camps in the U.S.

Johns Hopkins Engineering Innovation Program

Application Completion Checklist

Candidate Name
Name of High School
Year of Study
Age
Gender
Governorate

In order for your application to be complete, please make sure you have:

Completed Application Checklist Form (this page)

Completed Application (p 2-5)

Copy of official transcript (please do not submit original transcripts)

* All applications must be received via e-mail byApril 17, 2011 at 4:30 p.m. Any applications received after this time will not be considered. Please e-mail applications to:

2011U.S.-Egypt Science Year Summer Camps in the U.S.

Application Form

NAME :

First:

Middle:

Last:

CONTACT INFORMATION

Mailing Address
E-mail
Cell Phone
Home Phone
Work Phone

PERSONAL DATA

Gender
Date of Birth
(Month, Day, Year)
Place of Birth
(City, Country)
Country of permanent legal residence
Country of citizenship
If dual citizen, please indicate name of country
Year of Study (1st, 2nd, or 3rd year)

LANGUAGE PROFICIENCY

Number of years of English Study
Where Studied
Reading proficiency (Excellent, Good, Fair)
Writing proficiency (Excellent, Good, Fair)
Speaking proficiency (Excellent, Good, Fair)

PREVIOUS ACADEMIC HONORS/SCHOLARSHIPS

Please indicate any scholarships, academic awards, or honors that you have received and the year received:

NON-ACADEMIC/EXTRA CURRICULAR ACTIVITIES

Please list community service, internships, professional training, jobs, sports, or cultural activities in which you have participated regularly in the past two years. This includes any service as a team leader, council member, or officer in any institution or activity.

Institution Name, City, Country / Activity and Your Role / Dates of Participation
MM/YY – MM/YY
From: / To:
From: / To:
From: / To:

TRAVEL EXPERIENCE TO THE UNITED STATES OR OTHER COUNTRIES

Please describe any previous travel or study outside of Egypt.

Travel Dates
MM/YY – MM/YY / Travel Purpose
(e.g. vacation, school, etc.) / US Government
Program? Y/N
From: / To:
From: / To:

PERSONAL STATEMENT

Please answer the following essay questions in the box below. Feel free to use more space if needed.
SHORT ESSAY #1
Why are you interested in participating in the Engineering Innovation Program and what do you hope to gain from it?
SHORT ESSAY #2
Identify one scientific challenge facing Egypt today. What innovative scientific idea would you apply to solving this problem? Please explain the application of the scientific concepts that you would propose, including examples, graphics and data as needed.

2011 U.S.-Egypt Science Year Summer Camps in the U.S.
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