Competitive College Club (CCC)

Eligibility Requirements

  1. Students in grade 10 and 11
  2. Students in the top 10% of their class for the last three years in school (not less than an average of 80/100)
  3. Students committed to pursuing a Bachelor’s degree in the U.S.
  4. Students active in sports, community projects and/or the arts are preferred
  5. Students who are mature, flexible and can adapt to academic life in the U.S.

Instructions for completing this application: / All sections of this application must be fully completed in order to be considered for the program. Incomplete applications will not be considered. Please type or print using black or blue ink. Do not use pencil.

Personal Data

Name:______

First Name Middle NameLast Name

Gender:  Female Male

Do you ever spell your name differently? If so, how: ______

Email: ______

Home Telephone: Cell Phone: ______Fax:

Address: ______

City: Province or Region: Country:

Country of Permanent legal residence: ______

Citizenship(s): 1 2 3 ______

Birth Date: / / City of Birth: ______Country of Birth:

Day Month Year

Family Data

FatherLast Name: First name: ______

Occupation: Telephone: ______

MotherLast Name: First Name: _____

Occupation: Telephone: ______

Student lives with: Both parents Mother onlyFather only Other: ______

Parents are: Married Separated Divorced Other: _____

Family NameSexAgeRelationshipGrade level

Members:

1. _____

2. _____

3. _____

4. _____

Educational Data

School Name: ______

Address: ______Telephone: ______

Name of Principal: ______Type of School: Public Private

Language Proficiency

Native language(s): ______

Number of years of English study: ______Where studied: ______

Knowledge of foreign languages, including English (Rate your abilities as Excellent, Good, or Fair):

Language / Reading Ability / Writing Ability / Speaking Ability
  • Academic Honors- List any honors or distinctions you have won since the 9th grade:

Extracurricular, Personal & Volunteer Activities

Interests and Hobbies

List all extracurricular activities and all hobbies in which you have participated. Please state if you have received any awards, or if you have any outstanding achievements in these activities. Start with the most recent. You can attach a list or summary of your activities on a separate sheet if you like, and please be sure to highlight any leadership roles.

Activity / Number of Hours per Week / Month/Year Started / Month/Year Ended / Name of Award / Reason for Receiving Award / Date Received

Test Information

Please indicate your highest TOEFL, SAT I, and/or SAT II scores:

Test Name / Date taken or to be taken / Score
TOEFL
SAT I / Critical reading Math Essay
SAT II
Other

Intended Field of Study: ______

Short Essays

Please write an essay of 250-300 words maximum for each of the following topics:

  1. What are you planning to major in at the university? Why would you like to study in the USA? How will this experience help you in your future career goals?
  1. Describe a significant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you.

Financial Information Section

  1. How many people, including yourself, depend on the income of your parents for daily living expenses? ______
  1. During 2017, how much household income did your family receive from the following sources?

(Please indicate yearly amount for each category in US dollars.)

Fathers’ work / Family real estate holdings
Mother’s work / Pension
Your work / Other members of the household
Family business / Other (explain)

TOTAL YEARLY INCOME$ ______

  1. Will there be a significant increase or decrease in your family’s income next year?

No

Yes

If yes, please explain: ______

______

  1. Enter the amount of yearly support you can count on for your university costs from the sources listed below:

Sources / Amount of support per year in U.S.$
Student's assets or income
Father’s and mother’s incomes
Family's assets (savings, investments, business, etc.)
Relatives and friends
Private sponsor
Other
  1. Explanation/ Special Circumstances: Explain any unusual expenses, debts, or special circumstances that the university should consider when it is deciding how much financial aid it should offer you.

______

______

Student and Parental Consent:

My son/daughter has my permission to apply for the CCC Program administered by EducationUSA and AMIDEAST. I agree that my son/daughter is required to abide by all policies pertaining to attendance, behavior, punctuality and assignments. My child may be disqualified from the program if he/she does not adhere to these policies.

I hereby confirm that all information contained in this application is true and accurate and that I understand that my son/daughter may be removed from the program if it comes to the attention of either the CCC or AMIDEAST that any information provided in this application is not true or accurate.

Parent/Guardian’s signature: ______Date: ______

Student’s signature: ______Date: ______