2016ApplicationForm /
Applicant Information / Application Date:
Student`s Full Name:
School: / Grade (in 2016): / *RecommenderName:
Birthdate: / Gender: MaleFemale / RecommenderWorkplace:
Email: / @ / Recommender Position:
Address: / Recommender Email:
City:
Home phone: / Department:
Cel: / RecommenderTelephone:
Have you been a participant in a U.S. State Dept. Exchange Program? Yes No
If yes, which program and when?
What is your Grade Point Average? (please attach school reports for last 2 years) / 2014: / 2015:
List your academic achievements and/or awards:
List your extracurricular activities inside and outside of school (list in order of importance):
How would you assess your overalllevel of English?(choose one) / Advanced: / Intermediate: / Basic:
Haveyou taken any U.S. standardized tests? Yes No Results? / ACT:
/ SAT: / TOEFL:
*A recommender can be a teacher, coach, community leader, activity sponsor, or someone who knows you well who is not a family member. EducationUSA will contact recommenders as part of the selection process.
Opportunity Funds - Uruguay 20162016 Application Form /
Family Information
The information in this section is used only to help determine the financial need of the student.
Do you receive a school scholarship? Yes No / Are you employed?Yes No
Do you belong to an ethnic minority? Yes No / If so, to which one?
Do you have brothers or sisters? Yes No / If so, how many? Brothers Sisters
Do you live with both parents? Yes No / Do any other relatives live with the family? Yes No
Does your family own its home? Yes No / Does your family have a business? Yes No
Does your family own an automobile? Yes No / Year & model:
Mother`s Name: / Father`s Name:
Mother`s Occupation: / Father`s Occupation:
Mother`s Employer: / Father`s Employer:
Mother`s level of education: / Father`s level of education:
Please explain what you plan to study and why you want to study in the United States:
How did you find out about Opportunity? / Website/Facebook
School visit / Walk-in at EdUSA
USG program / Friend
Other:
The Opportunity Funds program requires that students commit at least two hours a day and regularly attend online sessions. Is the student able to commit this time to the program for at least 12 months? Yes No
Please email this application form with the following documents to
- Photocopy of your national ID card
- School transcript
- Letter of recommendation (from a teacher, school director, counselor, etc.)
- Other documents describing your participation in extracurricular activities, community service, leadership roles, etc.
- One-minute video in English describing why you are a good candidate for this program
- Parent’s authorization to participate in the Opportunity Funds program
- Documentation of bothparent’sincome (recibos de sueldo, etc.)
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Opportunity Funds - Uruguay 20162016 Application Form /
Write about a book, film, lecture or podcast you found memorable. Why did you enjoy it? (150 words)
Please choose one of your extracurricular activities and tell us more about it. (150 words)
Is there anything else you would like us to know about you? (150 words)
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