Download the Application Form (Microsoft Word Format)

 

 

 

APPLICATION FOR THE 2012 STUDY OF THE UNITED STATES

INSTITUTE FOR STUDENT LEADERS ON GLOBAL ENVIRONMENTAL ISSUES

 

1. Full Name (exactly as it appears on your passport)
   
   Last Name(s)
   First Name(s)
   Middle Name(s)
2.  Gender
3. Date of Birth (mm/dd/yyyy)
4. City of Birth
5. Country of Birth
6. Citizenship
7. Contact Information

Address:

Telephone:

Cell phone:

E-mail:

8. Medical, Physical, Dietary or other Personal Considerations
   Please state if you have any existing medical conditions or is currently taking any prescription medication.  This will not affect your selection, but will enable the host institution to make any necessary accommodations.
9. Academic Major
10. University/College
11. Year in University/College
12. Expected Graduation Date
13. Work and Volunteer Experience
14. Active Memberships (in Associations, Clubs, etc.)
15. Previous Experience in the United States

Please list any and all trips the candidate has made to the United States and include approximate dates and the reason for travel.

16. Family Residing in the United States

 Please list any immediate family members who are currently residing in the United States, including city and state.

17. Evidence of English Fluency, if any (e.g. paper-based TOEFL or iBT TOEFL scores, IELTS…)
18. Personal Statement (no more than 250 words)
    Please tell us about yourself and your goals including the following: What about your background and/or interests makes you competitive for this particular institute? What will you contribute to the group? How do you expect this experience will affect your future academic and professional career? How will it affect you personally? Please structure your essay in paragraphs.