Study in the United States Summer Institutes for Student Leaders from Europe

2018

Application Form



Personal Information:













































Family Name

First Name

Patronymic

(NOTE: AS IT APPEARS IN HIS/HER PASSPORT.)

Date of Birth (MM/DD/YYYY)

City of Birth

Country of Birth

Country of Residence

Country(ies) of Citizenship

Home Address

City

Cell Phone

E-mail


Emergency Contact Name and Relationship

(Example: John Doe, Father)

Cell Phone

E-mail

  Male

  Female

Medical, Physical, Dietary or other Personal Considerations

(This will not affect candidate selection, but will enable the host institution to make any necessary accommodations):

Academic Major, Institution:

Major (специальность по окончании вуза)

Institution (полное название вуза, факультет, в каком городе находится вуз)

Year in School (на каком Вы курсе в вузе )

Work and Volunteer Experience:





Memberships in Associations, Clubs, etc:

Please include dates (Example: Student Government, May 2011 to June 2012)


Please list any awards and certificates of achievements that demonstrate your leadership qualities, academic excellence and community activism.  Be prepared to send us scanned copies of these awards,

in case we need them (please do not send them now!)



U. S. Travel:

  Yes    No

Purpose

Date

  Yes  No

Family Residing in the United States: Please list any immediate family

members who are currently residing in the United States, including city

and state:

  Yes  No

English Proficiency:

Reading:

  Excellent

  Good

  Fair

Writing:

  Excellent

  Good

  Fair

Speaking:

  Excellent

  Good

  Fair

Personal Statement:

Tell us about yourself and your goals including the following: What about your background and/or interests makes you competitive for this particular institute (please be as specific as possible)?  What will you contribute to the group?  How do you expect this experience will affect your future academic and professional career?  How will it affect you personally? Please structure your essay in paragraphs and limit your response to approximately 250 words. (Просим печатать эссе здесь, то есть оно должно быть частью анкеты, а не отдельным документом)

НЕ нашли? Не то? Что вы ищете?





Please attach a scanned copy of your grades for the last two semesters (for second and third-year students), or a scanned copy of your school - leaving certificate (for first-year students).

/Для студентов 2 и 3 курсов: просим приложить к заявке отсканированную копию зачетки за последние ДВА семестра. Для первокурсников: просим приложить отсканированную копию Аттестата о среднем образовании.


Please attach at least one recommendation from a university professor. We would like to know why you are the best candidate for the program. The recommendation can be in Russian. / Просим приложить рекомендацию от преподавателя вуза. Мы хотели бы знать, почему Ваш студент является самым достойным кандидатом на программу. Рекомендация может быть на русском языке, но на ней должна быть подпись и контактная информация преподавателя.

Aнкеты без эссе, документов об успеваемости в вузе и рекомендации от преподавателя вуза рассматриваться не будут. 

Размер каждого приложения не должен превышать 2 МБ.

Также просим не архивировать файлы.

Please email completed applications to: *****@***gov

All e-mails should be clearly marked:

2018 SUSI Students: [LAST NAME, First Name] Application

2018 SUSI Students: [LAST NAME, First Name] Grades

2018 SUSI Students: [LAST NAME, First Name] Recommendation

Application deadline: December 17, 2017 (24:00 Minsk time)

Should you have any questions, please email to *****@***gov