Af.usembassy.gov



APPLICATION FORM FOR THE STUDY OF THE U.S. INSTITUTES (SUSI) WOMEN STUDENT LEADERS 2018The Public Affairs Section of the U.S. Embassy Kabul is soliciting applications from women student leaders for the 2017 Study of the U.S. Institutes (SUSI) for Student Leaders on Women’s Leadership. This is an intensive short-term academic program whose purpose is to provide groups of undergraduate women student leaders with a deeper understanding of the United States, while simultaneously enhancing their leadership skills. Participants are expected to be highly motivated first through third year undergraduate female students from colleges, universities, and other institutions of higher education; who demonstrate leadership through academic work, community involvement, and extracurricular activities. We encourage you to review the program content and read the requirements carefully before you apply. 7664621-280263***READ AND SIGN THE CHECKLIST CAREFULLY BEFORE COMPLETING APPLICATION***Application FormFollow 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 IdentityApplicant must enter her personal information accurately as it appears (or will appear) on her passport.Citizenship RequirementMust 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?Must be a female undergraduate student Between 18 and 25 years of age Applicants must have at least one semester left in her undergraduate studiesEnglish Language RequirementIt 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 United States, 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/CVAn up-to-date curriculum vitae (CV) or resume is required and is part of the application package.Letters of RecommendationOne recommendation letter from a professor or academic institutionLetter of recommendation must NOT be written by applicant’s relatives or friends.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 .doc or .docx format by email to KabulSUSIWomen@ before the deadline (Friday, November24, 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 WOMEN LEADERS APPLICATION FORM1. PERSONAL INFORMATION:Gender: Female Last Name: First Name: Date of Birth*: (Month-Day-Year): *This should match the date listed on your passportBirthplace: (City, Province) Country of Birth: National Identification Number: Marital Status: DO YOU NOW HAVE, OR HAVE YOU EVER HELD: U.S. CITIZENSHIP? FORMCHECKBOX Yes No DO YOU HAVE DUAL CITIZENSHIP WITH ANY OTHER COUNTRY? FORMCHECKBOX Yes No DO YOU HAVE U.S. LAWFUL PERMANENT RESIDENCY (GREEN CARD)? FORMCHECKBOX Yes No 2. 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. 3. PERMANENT MAILING ADDRESS:Street: City: Province: Country: Telephone: Work Phone: Mobile Phone: E-mail: 4. EMERGENCY CONTACT IN AFGHANISTAN: NAME, ADDRESS, EMAIL AND TELEPHONE NUMBER OF INDIVIDUALS TO BE NOTIFIED IN CASE OF AN EMERGENCY:Name: JPhone: E-mail: Relation to you: 5. 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:6. 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.7. EDUCATIONAL INFORMATION List educational institutions attended in reverse chronological order. include your field of studies at each one. INSTITUTION AND LOCATION(List in reverse order and write name in full)MAJOR FIELD OF STUDYDATES(Month and Year)FromToACTUAL NAME OF DEGREE OR DIPLOMA(Do not translate)DATE RECEIVED OR EXPECTED8.EXTRACURRICULAR AND COMMUNIRTY INVOLVEMENT: (List your extracurricular activities and community work, beginning with the most recent organization you are involved in. Make sure include if you hold a leadership position in any of them).NAME AND ADDRESS OF ORGANIZATIONTITLE/TYPE OF WORKDATES (Month and year)From To9. FUTURE PLANS: (250 words limit)Describe the career you plan to pursue after completion of study or research in the United States (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 have been promised a position in your home country after completing your undergraduate degree and/or U.S. training.10. LIST ANY ACADEMIC HONORS OR PRIZES AND SCHOLARSHIPS OR FELLOWSHIPS HELD AT PRESENT OR IN THE PAST (Give source or sponsor, amount, where held, and duration.) 11. KNOWLEDGE OF LANGUAGES: (Rate yourself as Excellent, Good or Fair Include all languages in which you have some competence.) Mother Tongue: LANGUAGEREADINGWRITINGSPEAKING12. TOEFL IBT RESULTS (in case you have it, please write the examination date and test score, include any other evidence of English proficiency)13. 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 visitCountry visitedDates of visit From (mo/yr) To ((mo/yr)14. 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.15. 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.16. RECOMMENDATION: List the name of a person from whom you have requested a recommendation letter.NAMEPOSITIONPHONE AND E-MAIL ADDRESS ................
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