Read and sign the checklist carefully before completing application


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APPLICATION FORM FOR THE

STUDY OF THE U.S. INSTITUTES (SUSI) SCHOLARS 2017
The Public Affairs Section of the U.S. Embassy Kabul is soliciting applications from scholars and professionals for participation in a five or six-week U.S. based program. This is an intensive graduate and post-graduate level academic program whose purpose is to provide participants with the opportunity to deepen their understanding of United States’ society, culture, values, and institutions.  The ultimate goal of the Institutes is to strengthen curricula and to enhance the quality of teaching about the United States in academic institutions abroad. We encourage you to review the programs content at the end of this application and review the requirements before you apply. For more information about this SUSI programs please visit U.S. Embassy Kabul website: http://kabul.usembassy.gov/step.html




***READ AND SIGN THE CHECKLIST CAREFULLY BEFORE COMPLETING APPLICATION***\\kabulwfs01.neasa.state.sbu\users\hashimif\desktop\fulbright_logo.jpg



Application Form


  • Follow the instructions carefully and answer all questions completely.

  • Each part of the application form must be completed in English. Incomplete applications will not be considered.

  • Do not exceed the space provided in text boxes.

Personal Identity

  • Applicant must enter his/her personal information accurately as it appears (or will appear) on his/her passport.


Citizenship Requirement


  • Must be Afghan citizens, currently residing in Afghanistan.

  • Applicants with a pending immigrant visa application, including SIV, are not eligible.

  • Program support for the recipient ONLY. Dependents, including spouses (Maharam), cannot accompany the recipient.


Who Can Apply?


  • Mid-career professionals

  • From higher education or research institutions


English Language Requirement



  • It is imperative that all candidates demonstrate English language fluency.  Institutes are rigorous and demanding programs; participants will be expected to handle substantial reading assignments in English and to be active participants in all seminar and panel discussions.  English fluency is vital to a successful experience in the institute.

Personal Statement

  • A narrative Personal Statement describing why you want to participate in this program, your personal philosophy, how your participation in this program will enhance your personal and professional development, improve education about the U.S., and how you will use your experience to help your country.

  • Currently employed applicants must also write about their professional responsibilities, research interests, and/or administrative responsibilities.

Resume/CV

  • An up-to-date curriculum vitae (CV) or resume is required and is part of the application package.

Letters of Recommendation


  • One recommendation letter from academic institutions and work supervisors are required.

  • Letters of recommendation must NOT be written by applicant’s relatives or friends.

  • All recommendation letters must be scanned and included in the application package.

Diploma Requirement

  • Applicants must have a minimum bachelor’s degree along with transcripts of 8 full semesters;





Supplemental Materials

(Check  when completed)

A complete application should include the following components
Completed Application Form Signed Application Instruction page

Copy of recommendation letter Updated CV



Submitting Complete Application




Applicants must print out this Checklist form, sign, scan and convert, with the completed Application Form and the rest of the Supplemental Materials, into one single PDF file. The PDF file name should include your full name and field of study.
Send the completed application in PDF and Word format by email to KabulScholarshipInfo@state.gov before the deadline (Monday, January 2nd 2017, 11:59 PM Kabul time). The subject line of your email must also include your full name and program name.







Applicant Name___________________________________ Signature________________________________________ Date____________________________

SUSI SCHOLARS APPLICATION FORM

1. Please mark which program you are applying for:


  1.  Institute on U.S. Political Thought

  2.  Institute on Contemporary American Literature

  3.  Institute on Journalism and Media

  4.  Institute on Religious Pluralism in the United States

  5.  Institute on U.S. Culture and Society

  6.  Institute on U.S. Foreign Policy


2. PERSONAL INFORMATION:

Gender:  Male  Female

Last Name:      

First Name:      

Date of Birth*: (Month-Day-Year):        *This should match the date listed on your passport

Birthplace: (City, Province)      

Country of Birth:      

National Identification Number/Tazkira:      

Marital Status:      
DO YOU NOW HAVE, OR HAVE YOU EVER HELD: U.S. CITIZENSHIP?  Yes  No

DO YOU HAVE DUAL CITIZENSHIP WITH ANY OTHER COUNTRY?  Yes  No
DO YOU HAVE U.S. LAWFUL PERMANENT RESIDENCY (GREEN CARD)?  Yes  No
3. PAST VISA APPLICATIONS: Have you ever applied for the Visa Lottery (Diversity Visa)? If so, please list the year(s) you applied. If someone else has applied on your behalf, or if your spouse or child has applied, please also include that information.

Has anyone ever filed an immigrant visa petition on your behalf or on behalf of your spouse or child? If so, list their name, relationship to you and when they filed the petition.

Have you, your spouse, or child ever applied for a Special Immigrant Visa? If so, please specify who, when, and what is the current status.

Have you ever applied for any other type of visa? If so, please list when, and what was the result.

Are you aware of any factor that might make you ineligible to receive a U.S. visa? If so, please explain.

4. PERMANENT MAILING ADDRESS:

Street:      

City:      

Province:      

Country:      

Telephone:      

Work Phone:      

Mobile Phone:      

E-mail:      
5. EMERGENCY CONTACT IN AFGHANISTAN:

NAME, ADDRESS, EMAIL AND TELEPHONE NUMBER OF INDIVIDUALS TO BE NOTIFIED IN CASE OF AN EMERGENCY:

Name:      

Phone:      

E-mail:      

Relation to you:      

6. INFORMATION FAMILY/CONNECTIONS IN UNITED STATES:

Please provide Name, Address, E-mail and Telephone number of individual contacts, relatives, or family members in the United States or Canada:

     

7. Medical, Physical, Dietary or other Personal Considerations:

Please state if you have any existing medical conditions or are currently taking any prescription medication. This will not affect candidate selection, but will enable the host institution to make any necessary accommodations.

     




8. EDUCATIONAL BACKGROUND

List educational institutions attended in reverse chronological order, including any in which you may be presently enrolled:



INSTITUTION AND LOCATION
(List in reverse order and
write name in full)


MAJOR FIELD OF STUDY

DATES
(Month and Year)
From To

ACTUAL NAME OF DEGREE OR DIPLOMA
(Do not translate)


DATE RECEIVED OR EXPECTED

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     



9. Identify your current position or occupation.

Write the position title which best describes the activity in which you are currently involved.

     


10. OCCUPATIONAL EXPERIENCE:

(List 5 years work experience, beginning with the most recent employment)



NAME AND ADDRESS OF EMPLOYER

TITLE/TYPE OF WORK

DATES (Month and year)

From To

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     






11. FUTURE PLANS: (Describe the career you plan to pursue after completion of study or research in the U.S. (e.g., teaching, government, business, industry or any plans you might have for continued study or research in your home country). Also indicate if you will be returning to former employment or if you have been promised a position in your home country after completing your U.S. training.
     



     
12. LIST ANY ACADEMIC HONORS OR PRIZES, SCHOLARSHIPS OR FELLOWSHIPS, HELD AT PRESENT OR IN THE PAST (Give source or sponsor, amount, where held, and duration.)



     



     

13. TEACHING EXPERIENCE: (Including any teaching positions you have held or currently hold.)


     

14. Research: (Including any research you have completed or in which you are currently involved.)


     

15. LIST ANY BOOKS, ARTICLES OR THESES PUBLISHED BY YOU, ESPECIALLY IN YOUR PROPOSED FIELD OF STUDY (Give title, place and date of publication)



     

16. LIST PROFESSIONAL SOCIETIES, FRATERNITIES OR OTHER ORGANIZATIONS IN WHICH YOU NOW HOLD MEMBERSHIP OR IN WHICH YOU HAVE BEEN ACTIVE IN THE PAST (Indicate if you have held an elective office.)



     

17. KNOWLEDGE OF LANGUAGES: (Rate yourself Excellent, Good or Fair Include all languages in which you have some competence.)

Mother Tongue

     



LANGUAGE

READING

WRITING

SPEAKING

English

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


18. HOW MANY YEARS HAVE YOU STUDIED ENGLISH?

     
19. TOEFL IBT RESULTS (in case you have it, please write the examination date and test score, include any other evidence of English proficiency)

     
20. Please indicate countries outside your own, including the United States, in which you have lived, traveled, or studied. Please list dates (months/years) and reasons for each visit.


Reason for visit

Country visited

Dates of visit

From (mo/yr) To ((mo/yr)

1.      

     

     

     

2.      

     

     

     

3.      

     

     

     

4.      

     

     

     

5.      

     

     

     



21. OTHER SCHOLARSHIPS: Indicate if you are planning to apply for a fellowship, scholarship, assistantship or other educational grant or loan from another organization, government or educational institution. Please also mention if you have applied for, or received any other scholarships in the past from the U.S. government. If you were not selected for the scholarship, please mention this. Please indicate the year(s) you applied and/or participated.

     
22. CONTACTS/ASSOCIATES: Do you know anyone else who has applied for a U.S. Embassy-sponsored scholarship or is applying for a scholarship now? If so, please name the person(s) and which scholarship they applied for or are applying for. If they have participated in an exchange program, please specify which one, and where the person is now.

23. RECOMMENDATION: List the name of a person from whom you have requested a recommendation letter.


NAME

POSITION

PHONE AND E-MAIL ADDRESS

I.

     

     

     



24. PERSONAL STATEMENT

Write about your education, practical experience, special interests, career plans, and your purpose in applying. Respond to the following questions:

  • Why do you want to participate in this SUSI program?

  • How will your participation in this program improve the teaching and knowledge of the United States in Afghanistan?

  • What do you hope to learn about American society and culture?

  • Which aspects of your own culture, history, etc. do you wish to share with American faculty and others in the community where you will be living?

  • If you are an educator or school administrator, what is your current teaching philosophy?

  • If you are a professional, how will this program enhance your work?

  • How will participation in the program benefit not only you, but also others (students, department, and administrators) at your home institution, and others in Afghanistan?


NOTE: Please limit your response to this page.

 Type here     

______. By checking this box, I certify that all of the information provided in my application and questionnaire is true and complete, and that if I lie about anything during the application process I may be banned from this government program and will be forever ineligible to participate in any other U.S. Embassy-sponsored program in Afghanistan. I also understand that if I have committed fraud or misrepresentation on this application, the U.S. Embassy may inform other scholarship-granting organizations that I have committed fraud. I understand that my candidacy for this program may be terminated at any time if it is found that I have lied during the application process or in my correspondence with the U.S. Embassy.

25. HOW DID YOU LEARN OF THE SUSI PROGRAM? (Please indicate all that apply.)
 Friend or relative (Specify)      
 Previous SUSI participant (Specify)      
 U.S. Embassy Kabul Website
 U.S. Embassy Kabul Facebook
 U.S. Embassy Kabul Twitter
 Other Internet Link (Specify)      
 Poster/Flyer      
University (Specify)      
Newspaper (Specify)      
Other (Specify)      


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