PUBLIC AFFAIRS SECTION

U.S. EMBASSY, TBILISI, GEORGIA

E-Teacher Scholarship Program

APPLICATION FORM

PUBLIC AFFAIRS SECTION, U.S. EMBASSY

E-mail:

Tel. 227 7889

Please submit the completed request form to the email address above by March 27, 2015.

In the subject line please indicate the name of the program

“E-Teacher Scholarship Program 2014-15” and your last name.

  1. CONTACT INFORMATION

FIRST NAME:

LAST NAME:

TITLE/POSITION:

INSTITUTION NAME:

PRIMARY E-MAIL ADDRESS:

SECONDARY E-MAIL ADDRESS:

CELL PHONENUMBER:

MAILING ADDRESS:

POSTAL INDEX:

  1. SELECTED COURSE TITLE:

(Please underline the selected course title offered for the Summer-2015 session: June 22 – August 28)

1. Introduction to Pedagogy and Practices for Teaching English to Speakers of Other Languages (TESOL Methods)

2. Building Teaching Skills through the Interactive Web (Web Skills)

3. Teaching English to Young Learners (TEYL)

4. Teaching English to Pre-teens and Teens (TEPT)

5. Critical Thinking in Language Learning and Teaching (CT)

6.Developing Local Leadership for Global English Language Teaching (Global English)

  1. REASONS FOR YOUR PARTICIPATION

Briefly explain why participation in the course is important for you and how and where you are going to share the gained knowledge. Please give specificexamples as to why this particular topic is relevantto your teaching. Please indicate your level of English, the number of years you have taught, and the age group of your students.

  1. PLEASE CONFIRM THAT YOU MEET THE REQUIREMENTS OF THE PROGRAM BY CHECKING THE BOXES BELOW:

__ Yes, I have regular and reliable access to high-speed Internet connection

__ Yes, I have requiredEnglish language reading and writing/typing skills

__ Yes, I commit to spending 10-15 hours a week on-line to participate in the course

__ Yes, I commit to share the gained knowledge through making presentations in my

region and at theEmbassy initiated events in other regions of Georgia