S

CENTER FOR EDUCATIONAL EXCHANGE WITH VIETNAM

a subsidiary of the American Council of Learned Societies

So 5, Ngo 52, Pho Giang Van Minh, Ba Dinh, Hanoi, Vietnam

Tel: 4-3723-6825 / Fax: 4-3723-6827 / E-mail:

APPLICATION FOR REGIONAL LANGUAGE STUDY FELLOWSHIP

2008 - 2010

This application is formatted to be typed by computer and must be submitted in the original format.

Select one (1) language below:

Hmong Thai Khmer Lao Indonesian Burmese

Name:
(As it appears in Vietnamese) / Male Female
(circle one)
Date of Birth (Day/Month/Year): / / Place of Birth:
Present position:
Field(s) of Specialization:
Department:
Institution name, with address:
Institution
Telephone (office): Fax:
Home address:
Home
Telephone (home): E-mail:

1.  Professional Background
Positions held (teaching, research, administrative), beginning with most recent.

Name of Institution Position Period of Employment

(month/year - month/year)

/ - /
/ - /
/ - /
/ - /

2.  Current Responsibilities: Please describe your work responsibilities in your current position, especially with regard to teaching and/or research. This section is formatted to allow you to type as many lines as needed.

3.  Language Study History

Name of Institution Language Period of Enrollment
(month/year – month/year)

/ - /
/ - /
/ - /

4. Personal Statement of Career Objectives:

In 1,000 words, please describe your past and present interest in the language you propose to study. What experiences and interests have influenced you to coninue studying this language? What are your professional and career goals? Discuss how learning this language will help you achieve these goals.

8. Emergency Contact: Please provide the name and relationship of the person to be notified in the case of emergency:

Name: / Relationship:
Address:
Telephone: / Email:

9. Signature:

I hereby certify that the information provided in this application is complete and accurate. If awarded a fellowship, I agree to comply with any necessary regulations and return to my home country upon expiration of my study program abroad.

Signature of Applicant: Date:

COMPLETED APPLICATION CHECKLIST

Submit the completed Application to the CEEVN-Hanoi office (address at the beginning of this application)

CEEVN will not be able to process applications that are missing required documents.

Required for all applications:

Completed & Signed Application Form

Personal Statement, 1000 words

Notarized copies of official university transcripts. Copies must be notarized. If the original documents were in Vietnamese, an English translation of each document must also be notarized.

Nomination Letter from Applicant’s Institution

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