U.S. Embassy in Afghanistan



APPLICATION FORMSTUDY OF THE U.S. INSTITUTES (SUSI) FOR SECONDARY EDUCATORS, 2019The Public Affairs Section of the U.S. Embassy Kabul is soliciting applications from secondary school educators and administrators for the 2019 Study of the U.S. Institutes (SUSI) for Secondary Educators. These are intensive post-graduate level academic programs with integrated study tours whose purpose is to provide foreign secondary school educators and administrators the opportunity to deepen their understanding of U.S. 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 secondary schools and other academic institutions abroad.? We encourage you to review the program content and read the requirements carefully before applying. 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?Mid-career, highly motivated and experienced secondary school teachers and administratorsBetween 30 and 50 years of age Applicants must have no prior or limited experience in the United StatesEnglish 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 your 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 componentsCompleted Application Form 2. Signed Application Instruction page 3. Copy of recommendation letter 4. Updated CV Submitting Complete Application Applicants must scan and combine all components of the application package into one single PDF file (maximum 5MB file size). Please submit the PDF file AND the completed Microsoft Word application form via email to kabulsusischolars@ before the deadline (Friday, November 30, 2018, 11:59 PM Kabul time). The two attachment file names should include your full name and field of study. The subject line of your email must indicate the program you are applying for. INCOMPLETE APPLICATIONS will not be considered. Applicant Name: Signature________________________________________ Date____________________________STUDY OF THE U.S INSTITUTES (SUSI) FOR SECONDARY EDUCATORS, 2019APPLICATION FORMNominee's Full Name, exactly as it appears on candidate's passportPrefix: Last Name:First Name:Middle Name:Gender: MaleFemaleDate of Birth (type mm/dd/yyyy):Birth City:Birth Country:Citizenship:Primary:Secondary (if applicable):Residency:Medical, Physical, Dietary or other Personal Considerations, Disability:Please describe any pre-existing medical conditions, including any prescription medication you may be taking, allergies, or other dietary or personal consideration. This will not affect selection, but will enable the host institution to make any necessary accommodations.Candidate Contact InformationAddress (No P.O Boxes):Street:City:Home State or Province:Postal Code:Home Country Name:Email: Phone numbers: Emergency Contact Name:Emergency Contact Relationship:Emergency Contact Number:Emergency Contact e-mail:Current Position, Title, InstitutionPrimary Position: Public Secondary School Teacher Private Secondary School Teacher National Curriculum/Exam Developer Teacher Trainer Textbook Writer Other: Please specify. ____________________________________Title: Organization Name: Organization Country: Work Experience, including previous positions and titlesOrganizationTitleFrom (Month and Year)To (Month and Year)Position (please specify if position is part-timeEducation, Academic and Professional Training:Please list all earned degrees and all current teacher qualifications you have such as certificates, licensures beginning with the most recent. Degrees and teacher qualifications listed should reflect the closest United States equivalent.Degree earnedYear earnedSpecializationInstitutionTeacher Qualification expiry dateAdditional Professional Training:Active Professional Memberships:Active Professional Memberships independent of current professional responsibilities. These should not include university or school committee work or other professional duties directly related to current employment.PositionTitleOrganizationPublications Related to the Institute Theme (up to 10)Please list all foreign titles in English, including whether book, chapter, journal article, newspaper article, web article, etc.Publication TypeYearTitlePublisherPrevious Experience in the United StatesHave you travelled to the U.S. before? Yes?No?PurposeFromToDescriptionFamily/Friends Residing in the United States or CanadaDo you have close family residing in the U.S.? Yes ? No ?If yes, please fill out the following section; if no, please write 'None'. Note: Having close family residing in the U.S. will not affect your application. NameSurnameCityStatePhone/EmailEvidence of English Fluency(University Diploma, State Language Certificate, IELTS, Pitman, TOEFL, etc.)TOEFL IBT Results: (Share your TOEFL score if you have and indicate the examination date. Please include any other evidence of your English proficiency)TestDateScoreKnowledge of other Languages: (Rate yourself as Excellent, Good or Fair. Include all languages in which you have some competence.)Native Language: LanguageSpeakingReadingWriting Professional ResponsibilitiesPlease discuss your professional responsibilities in greater detail, including research interests, administrative responsibilities (ex. curriculum design), and/or other pertinent information.Current Courses Taught:Course TitleLevel of StudentsClassroom Hours Per Semester# StudentsU.S. Studies Content (%)Current Extra-Curricular/Co-Curricular Activities LeadershipActivityPosition/TitleFromToDescription of DutiesOther Potential Outcomes:Please select any likely potential professional outcomes of this program. Update Existing Course Create New Course Create New Degree Program School Curriculum Redesign National Curriculum Redesign New Research Project New Publication Professional Promotion Government or Ministry Policy New Professional Organization New Institutional Linkages Raise Institutional ProfilePersonal essay (Limit 250 words)Please discuss how your participation would enhance your personal and professional goals, the current state of U.S. studies in your home country, or upon the institute. Include how attending this Institute would help you achieve the "Other Potential Outcomes" you have checked above.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. Type of VisaYear AppliedCurrent application statusNames of family members who also applied and year of applicationHas 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. NameRelationshipYear AppliedAre you aware of any factor that might make you ineligible to receive a U.S. visa? If so, please explain. Recommendation: List the name of a person from whom you have requested a recommendation letter.NamePositionPhoneEmail address ................
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