Study of the United States Institutes for European Student Leaders
Application Form

Application form, academic transcript, and one letter of recommendation from an individual whoknows you in a professional capacity should be submitted no later than Sunday, December 10, 2017, to Fulbright Finland Foundation, e-mail: office(at)fulbright.fi
A. Title of Institute (e.g. Civic Engagement or Social Entrepreneurship):

B. Nominees Full Name, Exactly As It Appears on Nominee's Passport
Last Name:
First Name:
Middle Name:
C. Gender
Male Female
D. Date of Birth (type e.g. 2/24/1995) (mm/dd/yyyy)
E. City of Birth
F. Country of Birth
G. Citizenship
Primary:
Secondary:
H. Residency (country of residence)
I. Medical, Physical, Dietary, or other Personal Considerations
Disability: / Select... Blind and Visual Impairments Deaf and Hearing Impairments Learning Disability New Disability Description Physical Disability Psychiatric Disability Systemic Disability
Please describe any pre-existing medical conditions, including any prescription medication, or any other dietary or personal consideration.
This will not affectthe nominee's selection, but will enable the host institution to make any necessary accommodations.
J. Contact Information
Address:
City:
Postal Code:
Home Country:
Email:
Phone:
Emergency Contact Phone:
*Numbers only
Emergency Contact Name and Relationship: *Example: John Doe, Father
Emergency Contact Email:
K. Academic Major and Home Institution
Home Institution Name:
Country:
Major Academic Field:
L. Work and Volunteer Experience
M. Year in School
Select... Completed First Year Completed Second Year Completed Third Year Completed Fourth Year Completed Degree Master's Student
N. Memberships in Associations, Clubs, etc.
*Please include dates (Example: Student Government, May 2015 to June 2016)
O. HaveYou Travelled to the U.S. Before:
Select... Yes No
if yes, please specify below.
From: To:
(Type mm/dd/yyyy )
Purpose:
P. Family Residing in the United States
Select... Yes No
if yes, please specify below.
*Please include city and state (Example: John Doe -Chicago, IL)
Q. Evidence of English Fluency (Please comment on your level of English fluency)
R. Personal Essay (250 words limit)
The essay shouldbe no more than 250 words and should conveywhy you are interested inparticipating in theparticular Institute, what you expect to gain, and what you will contribute to the Institute. In addition, the essay shouldconvey information onyour background and/or interests that makesyoucompetitive for this particular Institute.