COMMUNITY COLLEGE SUMMIT INITIATIVE PROGRAM



10584718909200-478620361100Community College Initiative ProgramStudent Application 2021-2022Before completing this application, you must read all of the information at . On this website, you will find complete information about the Community College Initiative (CCI) Program, eligibility requirements, application requirements, additional required documents that must be submitted, and deadlines.Please complete all questions on this application in English. If the question does not apply to you, write N/A.Personal InformationFull name (as listed on cédula)First Name:Second Name:Last Names:Address where you liveStreet and number: City: Department:Phone number:E-mail:Gender:Marital status:? Single? MarriedDate of birth:Month:Day:Year:Age: Country/Countries where you are a citizen:Where were you born?City:Country:Have you participated in any programs related to the U.S. Embassy? Yes ? No ? If yes, program name:Year(s) you participated:English ProficiencyEnglish exam or certificate you are using to meet the English language requirement to apply for the CCI Program: Name of English exam/certificate/program: English level:Remember that in order to be considered for the program, you must provide a certificate or results that clearly shows a minimum B1 level or equivalent (Common European Framework).Proposed Field of Study Applicants must apply in only one field of study. Select your preferred field of study from the options below. Then, select two or three concentration areas in that same field of study and note the order of your preference. The concentration areas all must be in the same field of study.Field of Study (choose 1):Concentration Area (choose 2 or 3):Rank Order Preference (1 is highest, 3 is lowest)?Agriculture?Agribusiness 1?2?3??Agricultural Geospatial Technology 1?2?3??Agricultural Production Management 1?2?3??Animal Science1?2?3??Environmental Horticulture and Conservation1?2?3??Parks and Natural Resources 1?2?3??Small Scale Food Production1?2?3??Sustainable Agriculture 1?2?3??Applied Engineering?Architecture 1?2?3??Automotive Technology or Service Management1?2?3??Computer Aided Design 1?2?3??Construction Management 1?2?3??Electro Mechanical Technology1?2?3??Electrical Systems Maintenance 1?2?3??Electrical Technology1?2?3??Electricity and Electronics Technology1?2?3??Heating Ventilation and Air Conditioning 1?2?3??Machine Repair: Automated Systems1?2?3??Manufacturing Technology 1?2?3??Mechatronics 1?2?3??Robotics 1?2?3??Welding1?2?3??Early Childhood Education?Administration of an ECE Center1?2?3??Early and School-Age Care Specialist1?2?3??Early Childhood Education and Development1?2?3??Special Education1?2?3??Information Technology?Computer Information Systems (CIS)/Computer Science (CS)1?2?3??Computer Internetworking Technologies (CIT)1?2?3??Geographic Information Systems (GIS)1?2?3??IT Technician: Desktop Support, Computer Support, Network Technician1?2?3??Media?Digital Media/Animation1?2?3??Film Studies/ Motion Picture/ Television1?2?3??Graphic Design1?2?3??Journalism1?2?3??Public & Media Relations1?2?3??Social Media Marketing1?2?3??Web Design1?2?3??Web Development1?2?3??Public Safety?Fire Sciences, Protection and Safety1?2?3??Emergency Services 1?2?3??Tourism and Hospitality Management?Hospitality and Hotel Management1?2?3??Culinary Arts and Restaurant Management1?2?3??Meeting, Event, and Exhibition Planning1?2?3??Tourism1?2?3?Background InformationEducational HistoryAre you currently a student? ? Yes ? NoName of institution:How many semesters have you completed?Please fill out the following chart based on your educational history. Start with your current or your most recent institution. Please list information for your high school studies and for any studies (technical/vocational, university, etc.) after high school.Name of institutionLocation of institution (city, department)When did you start your studies?(Month/Year)When did you finish your studies?(Month/Year)Have you received a degree?What is/was your area of study?Have you received a scholarship or funding for any of your studies? ? Yes ? NoIf so, please describe the scholarship:Work ExperienceAre you currently employed? ? Yes ? No List the jobs you have had, beginning with your current or most recent employment. Name of company or employerPosition titleWhen did you start working?(Month/Year)When did you stop working?(Month/Year)Job responsibilitiesLeadership and Community Service ExperienceLeadership and community service are fundamental parts of the CCI program and the selection process. Please list any experience you have as a volunteer and/or any experience as a participant or leader in extracurricular activities or organizations.. Title or name of project/activityLeadership position held (if applicable)When did you start the activity? (Month/Year)When did you finish the activity? (Month/Year)Describe your involvement in this project/activityHave you ever traveled outside of Colombia? ? Yes ? No If yes, please fill out the following information for any trips outside of Colombia:Country/Countries visitedTravel start date(month/day/year)Travel end date(month/day/year)Purpose of travel: vacation, studies, work, other (explain)Who paid for the expenses related to your trip?How did you find out about the CCI Program? (Check all that apply.)? U.S. Embassy social media? Social media account of other institution? Friend or family member? EducationUSA? Former grantee? Other – please explain: QUESTIONSFor all questions below, please type your answers below or on the following page. Please follow the word limits listed with each question. Short Answer #1 (maximum 125 words)Describe growing up in your home. Explain where you grew up, who lived in your home with you, what your parents’ job responsibilities were during your youth (if they were employed), and what your surrounding community was like. Short Answer #2 (maximum 125 words total)a.) What does leadership mean to you? b.) Do you consider yourself a leader? If yes, what is an example of a time when you demonstrated leadership?Short Answer #3 (maximum 125 words)Please describe a problem or obstacle in your educational or personal life. How did you overcome it? Short answer #4 (maximum 125 words)The CCI Program prioritizes students from underserved or underrepresented communities. Describe how these criteria applies to you.Short answer #5 (maximum 125 words) Describe a time when you have demonstrated the ability to go above and beyond what was expected of you.Essay #1 (maximum 200 words total) Within your proposed field of study, what specifically do you want to study? Describe your related experience within the field you want to study. How will this program of study build on your past education, training, and/or experiences in this field of study? Alternatively, if you are new to this field, why did you choose this field? Essay #2 (maximum 200 words) How will your participation in the CCI program support your educational and personal development goals, during and/or after returning from the program? Community College Initiative Program Application Certification StatementI certify that I completed this application myself, that the information given in this application is complete and accurate, and that I have carefully read and understand it.I certify that I have read and I understand all of the information about the program on the U.S Embassy Community College Initiative webpage: understand that program administrators reserve the right to verify all the information listed in the application. I understand that giving false or misleading information in the application will eliminate me from the competition or cause my dismissal from the Community College Initiative Program.I acknowledge that I am aware of the following program requirements:I must follow all program rules and regulations and observe all the laws of the United States during my stay there.At the end of the academic year program, I will return to my home country and fulfill a two-year, home-country residency requirement in compliance with the terms of my J-visa. I understand that I may not extend my program dates.The health benefits coverage provided to me during my travels is intended only for emergencies and does not cover pre-existing or dental conditions.My spouse, children, other relatives or individuals are not permitted to accompany me to the United States on the program._________________________________________________________________________Signature of applicantDate (month/day/year)Note: It is not necessary to print this form and sign physically. You may sign electronically by typing your full name and the date in the spaces provided. By signing electronically, you agree to the entirety of the certification statement on this page. ................
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