Student Application 2018-2019 Personal Information



Download 191,89 Kb.
Date conversion06.05.2018
Size191,89 Kb.


Community College Initiative Program

Student Application 2018-2019

Personal Information


Name of applicant as indicated on passport if passport is already issued. Please type or print.

______________________________ _________________________ ________________________________

SURNAME/FAMILY NAME First/Given Name Middle Name(s)

(write in all capital letters)

Home Address:

Street and number:


City:

State/province:

Postal code:

Country:


Home Phone:



Mobile Phone:




E-mail:
Gender:

☐ Male


☐ Female

Marital status:


☐ Single

☐ Married


Do you have a passport?


☐ Yes

☐ No


Date of birth (month/day/year):

Month of birth:

Day of birth:

Year of birth:


Country/Countries of citizenship:


Country/Countries of permanent residence:



Place of birth (city or town and country, as listed in passport, if available):

City of birth:

Country:

Are you currently a student? Yes No


If yes, what is the course of study you are pursuing?
Are you enrolled in a degree program? ☐ Yes ☐ No
Please list the name of the degree:
How many years toward the degree have you completed?


Name of college/institution where you are enrolled:

Date you anticipate completing your degree:



What is the highest educational degree you have completed? Please list the degree and the number of years of postsecondary of study.

Have you participated in any U.S. government exchange program? Yes ☐ No ☐

If yes, give name of the program:

Duration of the program : Year you participated:



Your proposed Field of Study during the Community College Initiative Program:


Applicants must apply in only 1 field of study. Select your preferred field of study from the options below.

Then, select 2 or 3 concentration areas in that same field of study and note the order of your preference.

Field of Study

(check 1):
Concentration Area

(check 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 Science

1☐

2☐

3☐



☐Environmental Horticulture and Conservation

1☐

2☐



3☐

☐Parks and Natural Resources

1☐

2☐

3☐



☐Small Scale Food Production

1☐

2☐



3☐

☐Sustainable Agriculture

1☐

2☐

3☐



☐Wastewater Purification

1☐

2☐



3☐
☐Applied Engineering
☐Architecture

1☐

2☐



3☐

☐Automotive Technology

1☐

2☐

3☐



☐Computer Aided Design

1☐

2☐



3☐

☐Construction Management

1☐

2☐

3☐



☐Electro Mechanical Technology

1☐

2☐



3☐

☐Electrical Systems Maintenance

1☐

2☐

3☐



☐Electrical Technology

1☐

2☐



3☐

☐Electricity and Electronics Technology

1☐

2☐

3☐



☐Heating Ventilation and Air Conditioning

1☐

2☐



3☐

☐Machine Repair: Automated Systems

1☐

2☐

3☐



☐Manufacturing Technology

1☐

2☐



3☐

☐Mechatronics

1☐

2☐

3☐



☐Robotics

1☐

2☐



3☐

☐Welding


1☐

2☐

3☐


☐Business Management and Administration

Banking and Finance
☐Accounting

1☐

2☐



3☐

☐Banking

1☐

2☐

3☐


☐Bookkeeping

1☐

2☐

3☐



Entrepreneurship
☐Business Planning

1☐

2☐



3☐

☐Entrepreneurship

1☐

2☐

3☐


☐Small Business Management

1☐

2☐

3☐



Marketing and Public Relations
☐Customer Service

1☐

2☐



3☐

☐Marketing

1☐

2☐

3☐


☐Promotions and Public Relations

1☐

2☐

3☐


☐Social Media Marketing

1☐

2☐

3☐



Management and Administration
☐Administrative Professional

1☐

2☐



3☐

☐Business Management

1☐

2☐

3☐


☐Business Operations Support Services

1☐

2☐

3☐


☐Human Resources

1☐

2☐

3☐


☐International/Global Business

1☐

2☐

3☐


☐Leadership Development

1☐

2☐

3☐


☐Logistics and Global Supply Chain Mngmt

1☐

2☐

3☐


☐Manufacturing

1☐

2☐

3☐


☐Non-Profit Leadership and Administration

1☐

2☐

3☐


☐Organizational Leadership

1☐

2☐

3☐


☐Project Management

1☐

2☐

3☐


☐Sales


1☐

2☐

3☐



Your proposed Field of Study during the Community College Initiative Program:


Applicants must apply in only 1 field of study. Select your preferred field of study from the options below.

Then, select 2 or 3 concentration areas in that same field of study and note the order of your preference.

Field of Study

(check 1):
Concentration Area

(check 2 or 3):
Rank Order Preference

(1 is highest, 3 is lowest)
☐Early Childhood Education
☐Administration of an ECE Center

1☐

2☐



3☐

☐Early and School-Age Care Specialist

1☐

2☐

3☐



☐Early Childhood Education

1☐

2☐



3☐

☐Special Education

1☐

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 Technician

1☐

2☐

3☐


☐Media
☐Digital Media/Animation

1☐

2☐



3☐

☐Film Studies/ Motion Picture/ Television

1☐

2☐

3☐



☐Graphic Design

1☐

2☐



3☐

☐Journalism

1☐

2☐

3☐



☐Public & Media Relations

1☐

2☐



3☐

☐Social Media Marketing

1☐

2☐

3☐



☐Web Design

1☐

2☐



3☐

☐Web Development

1☐

2☐

3☐


☐Public Safety

☐Fire Sciences, Protection and Safety

1☐

2☐

3☐



☐Emergency Services

1☐

2☐



3☐
☐Tourism and Hospitality Management
☐Hospitality and Hotel Management

1☐

2☐



3☐

☐Culinary Arts and Restaurant Management

1☐

2☐

3☐



☐Meeting, Event, and Exhibition Planning

1☐

2☐



3☐

☐Tourism


1☐

2☐

3☐


To pursue certificates in a field of study, you will likely be required to repeat entry-level courses you have taken in your home country to meet prerequisite requirements for the certificate. Official copies of any post-secondary transcripts and course syllabi or other documentation of course content and your performance may be considered for evaluating if you have already satisfied the prerequisite requirements, but this process requires precise documentation and is not guaranteed.

Knowledge of Languages: Rate yourself Excellent, Good, Fair, or Poor. Include all languages that you speak or have studied, including English. List your native language first.

Language

Reading

Writing

Speaking

Listening















































Language proficiency If you have taken any standardized test of English language proficiency (for example TOEFL, TOEIC, IELTS) please list the test taken, give the results, and provide a copy of the test results.
Test Taken: Date Taken: Results (also attach copy):





Background Information


Educational History. Please list educational institutions that you are currently attending or have attended with the most recent listed first. Please attach a translated and certified copy of your transcripts for any institution from which you received a certificate, diploma, or degree.

Name of Institution/Location

Major Field of Study

Dates Attended (Month, Year)

From To

Actual Name of Degree or Diploma (Do not translate)

Date Received







































Work Experience: Are you currently employed? Yes No
List jobs held, begin with current or most recent employment. (Continue on additional sheets of paper, if necessary)

Name and address of employer

Position held

Date

From:

(Month/
Year)


Date

To:

(Month/
Year)


Responsibilities

Current Position:














































Professional Experience: In addition to jobs held, please list relevant professional non-paid, volunteer and/or leadership positions or experiences.

Position

Date

From:

(Month/
Year)


Date

To:

(Month/
Year)


Responsibilities









































If you have traveled or lived in any country other than your own, indicate places, dates (month and year) and purpose. (Continue on additional sheets of paper, if necessary)

Country

Dates

Purpose





























Below, provide the names, addresses and telephone numbers of individuals to be notified in case of an emergency.

Name of individual

Location & address of individual


Indicate relationship to you (father, mother, friend, etc.)

Languages this person speaks

List contacts in your country



















List contacts in the United States














Please list family members who have participated in a U.S. government-sponsored exchange program in the United States. (Continue on additional sheets of paper, if necessary)

Name of individual


Relationship


Name of program

Program dates
































Please list any family members who are currently applying to participate in a 2018 or 2019 U.S. government-sponsored exchange program in the United States. (Continue on additional sheets of paper, if necessary)

Name of individual


Relationship


Name of program

Program dates























Essays

Essay #1: Within your proposed field of study, what do you want to study? Please describe in detail your specific concentration areas of interest within your field of study. (Your response should be a minimum of two paragraphs. Your response helps us to match your interests with college programs.)




Essay #2: Please describe your related experience within this field of study. How would this program of study build on your past education, training, and/or experience? If you are new to this field, why did you choose this field? (Your response should be a minimum of two paragraphs. Your response helps us to match your interests with college programs.)




Essay #3: Please describe your short term goals that you want to accomplish during the CCI Program in each of the following areas. (Your response should be a minimum of one paragraph for each area.)


Professional and/or educational goals:





Personal development goals:





Learning about U.S. culture and sharing your culture with others:









Essay #4: Please describe your long-term goals that you want to accomplish in the first few months upon returning home after the CCI Program. (Your response should be a minimum of one paragraph for each area.)


Professional and/or educational goals:





Personal development goals:





Sharing what you have learned and giving back to your local community after the CCI Program:






How would the CCI Program help you to achieve these goals?


Essay #5:

a.) What are three leadership traits or characteristics that are important to you?

b.) Give an example of a time that you demonstrated at least one of these traits and improved a situation.



Essay #6: Please describe a problem or challenging situation in your educational, professional, or personal life and describe how you resolved it and what you learned from this situation. How did you demonstrate flexibility during this challenging time?



Essay #7:

a.) Living in shared housing with diverse, multinational participants is challenging! Give an example of a time that you had a conflict with a colleague and describe what you learned about how to be successful in resolving conflict.

b.) Consider this scenario: You like to study at night; your roommate likes to practice his guitar at night.

How would you handle this situation?


Essay #8: Consider this scenario: You have just woken up. You have an exam tomorrow which you have not started studying for. You have a class scheduled today from 2pm to 5pm. You have also signed up for a volunteering activity in the evening with your cohort. You have a group project for a class that is due in two days.
What are your priorities and how would you organize your schedule?



Community College Initiative Program

Application Certification Statement
Certification: I 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 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.
Also, 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.


_________________________________ ________________________________________

Signature of applicant Date (month/day/year)


The database is protected by copyright ©sckool.org 2016
send message

    Main page