FORECAST Exchange Program2010-2011

Application form

ECAST CHANG

E APPLICATION

FORECAST EXCHANGE APPLICATION

2010-2011

FORECAST EXCHANGE

Undergraduate Program

APPLICATION DEADLINE: 5:00 PM, JANUARY 16, 2008

APPLICATION DEADLINE: 5:00 PM, JANUARY 15, 2010

FORECAST EXCHANGE PROGRAM UNDERGRADUATE APPLICATION 2010/2011

PERSONAL INFORMATION

1. Full legal name
First Name: / Father’s name:
Last name:
2. Gender
Male / Female
3. Current address
Street: / Number:
City: / Zip code:
4. Current telephone: / Mobile:
5. Permanent address (from your passport)
Street: / Number:
City: / Zip code:
6. Email address:
7. Date of birth (month/date/year): / 8. Place of birth:
9. Citizenship: / 10. JMBG:
11. Parents’ or guardians’ information
Name: / Street and number:
City: / Zip code:
Home telephone (with area code): / Work telephone:
12. Passport
Passport number:
Date of Issue: / Valid until:
Issuing city and country:

EDUCATIONAL INFORMATION

13. Are you currently enrolled as a full-time student in an institution of higher education? / Yes / No
14. Name of the University:
Name of the Faculty:
Address of the Faculty:
Department:
Dean’s name and telephone number:
Please indicate your current year of study:
How many years do your studies last?
15. Please list courses that you would like to take within your major field of study (be as specific as possible):
16. Please list courses that you would like to take outside your major field of study:
17. Please list all universities you have attended:
University and City / Dates of Attendance
From: mm/yy To: mm/yy / Department / Date Degree Received or expected mm/yy
Please list all secondary schools you have attended:
School name and City / Dates of Attendance
From: mm/yy To: mm/yy / Major field of study / Date Degree Received mm/yy
Please list any other academic or non-formal education program you have attended:
Institution and City / Dates of Attendance
From: mm/yy To: mm/yy / Program / Date of Program Completion mm/yy
18. Honors and awards received:
19. English study
How many years altogether have you studied English in elementary and secondary school?
Did you study English at a special English school or an institute?If yes, at which? / How many years?
Have you had private tutoring in English? / How many years?
20. Have you taken the official Test of English as a Foreign Language (TOEFL)? / Yes / No
If yes,
Type (check one): / Date Test Taken: / Location / Score
-paper-based
-computer-based
-internet-based
21. Have you taken an official Cambridge Test? / Yes / No
If yes,
Which (check which ones): / Date Test Taken: / Location / Score
-First Certificate
-Advanced
-Proficiency
22. Please provide information regarding education received in languages (Including your native language) other then English:
Language / Number of years / Location
Native language
Second language
Third language
23. Have you ever studied in the United States at a high school? / Yes / No
If yes, when and where?
What were the circumstances of the study program? (scholarship, self-funded)
24. Have you ever applied to an US College or University? If Yes, please indicate the name and institution and the type of program for which you applied (for example, “4-year degree program at Grinnell College”).
25. Have you ever studied in the United States at an undergraduate institution? / Yes / No
If yes, when and where?
What were the circumstances of the study program? (scholarship, self-funded)
26. Other than any high school or university exchange in the US as described in # 23 or #25 have you ever been to the United States (please indicate the dates, locations and type of visa).
27. Are you currently employed? / Yes / No
If yes, please write name of the organization:
Job title:
How long have you worked there?
Major duties:
28. Do you currently do any volunteer work or actively participate in some NGO? / Yes / No
If yes, please describe:
How long have you volunteered there?
Major duties:

PLACEMENT INFORMATION

The following information will not be considered in the evaluation of your application or selection process. It will assist in your placement at a university and with a roommate, should you be selected to participate, as well as other logistical needs.

29. Do you smoke? / Yes / No / Do you mind living with someone who smokes? / Yes / No
30. What kind of music do you like?
31. What time do you usually go to bed?
32. What time do you usually get up?
33. How would you describe yourself (neat, messy, noisy, quiet, etc.)? :
34. What kind of university clubs or extracurricular activities would you like to participate in while at a U.S. university? :
35. Please list your hobbies and interests:
36. Do you have any allergies? / Yes / No
If yes, what? :
37. Do you have any food restrictions? / Yes / No
If yes, what?
38. How did you hear about the FORECAST Exchange program? Please, specify.
US Embassy / Presentation (where):
Faculty / Television:
Radio: / Newspaper:
Web page: / Other:

PERSONAL STATEMENTS

Please answer all three questions in clear concise English. Statements should be done on a computer or typewritten. You may attach additional sheets of paper if you need more space to answer questions 39, 40, and 41.

39. What are your academic goals for study in the US?

40. What have you experienced in the past that has prepared you for living in the United States for one year?

41. What do you think you can contribute to this program and to university life in the United States?

42. Please answer only one of the following questions. Your statement should be at least one typewritten page in length, but no longer than two pages. Please attach an additional sheet of paper. This is a very important part of the evaluation process.

What motivates you in life and why?

Why do you think community service is a required part of the FORECAST Exchange Program? What do you believe can be achieved? Do you have any experience with volunteering? Please Describe.

You are a journalist and can have an exclusive two-hour interview with any person (living or dead) of your choice. Who would it be and why? What would you ask him or her? (The person does not have to be famous.)

CERTIFICATION

Student’s name: ______

ACADEMIC RECOMMENDATION FORM

To be completed by a University Professor familiar with the student’s work in his or her major field of study. Recommendations should not be from family members or friends.

Instructions: Your statement will be given considerable importance by the American universities and colleges reviewing the student’s application, and therefore should be as complete and detailed as possible. Please, include your candid evaluation of the student’s ability to participate in such an exchange program by indicating:

a)in what context you know the student;

b)how you would describe the mentality and adaptability of the student in difficult situations;

c)the qualities that would make the student a successful exchange student including their interaction with others.

This recommendation should be typewritten or clearly printed in English, if possible. If not in English, an accurate translation must be attached. Your comments can be continued on the reverse side or a separate page.

Recommended by:
Place of Employment:
Address:
Telephone:
Signature:
Date:

Student’s name: ______

SECOND RECOMMENDATION FORM

To be completed by a Professor familiar with the student’s work in his or her major field of study, OR from an employer, former exchange program coordinator or host family, coach, or any supervisor or authority familiar with the student’s extra curricular activities. Recommendations should not be from family members or friends.

d)in what context you know the student;

e)how you would describe the mentality and adaptability of the student in difficult situations;

f)the qualities that would make the student a successful exchange student including their interaction with others.

Recommended by:
Place of Employment:
Address:
Telephone:
Signature:
Date:

This application is free and may be reproduced.

Applications are also available via the Internet at

Deadline:5:00 PM, Thursday January 15th, 2010