APPLICATION FOR ADMISSION TO THE
HUBERT H. HUMPHREY FELLOWSHIP
PROGRAM- 2010-2011
FOR MID-CAREER PROFESSIONAL DEVELOPMENT
IN THE UNITED STATES
Information and Application
Instructions
PROGRAM DESCRIPTION:
The Humphrey Fellowship Program provides
mid-career professionals from designated countries of Africa, Asia, Latin
America, the Caribbean, the Middle East, Europe and Eurasia with an
opportunity to enhance their professional capabilities through participation
in specialized, 10-month, non degree programs developed specifically for
small clusters of Humphrey Fellows at selected U.S. universities. The
Humphrey Program was initiated in 1978 to honor the memory and
accomplishments of the late Senator and Vice President, Hubert H. Humphrey.
Fellows are selected based on their potential for national leadership and
commitment to public service, in either the public or private sector. The
program provides a basis for establishing long-lasting productive
partnerships and relationships between citizens of the United States and their
professional counterparts in other countries, fostering an exchange of
knowledge and mutual understanding throughout the world.
Funding for the Humphrey Program is provided
by the U.S.
government through the United States Department of State and other
co-sponsors. The Institute of International Education (IIE) collaborates with
the State Department's Bureau of Educational and Cultural Affairs in
administering the program. The types of university programs arranged for
Humphrey Fellows depart from a traditional discipline-oriented focus and have
a problem-solving and experience-sharing emphasis. The programs are not
degree-related or aimed at providing scholarly preparation or basic training
in a field. The objective is to provide Humphrey Fellows with an overall
experience that broadens their perspectives, enhances their capability to
assume greater career responsibilities, and provides opportunities to
establish useful professional contacts. To accomplish these objectives,
programs are designed to include various combinations of course work,
independent projects, internships, consultations with U.S. faculty or experts, field
trips, and special seminars. Under the guidance of a designated faculty advisor
or “coordinator,” Fellows plan programs that best suit their individual
career development needs.
DURATION OF GRANT: The program arranged for Humphrey Fellows
extends from August or early September to the following June. Applicants who
need additional English training may be required to arrive in the United States
as early as April for intensive language study before beginning their regular
university program. Candidates must be able to participate in the full period
of the English and/or university programs.
NONDEGREE STATUS: The program designed for Humphrey Fellows
does not result in the awarding of a degree. While Fellows are able to enroll
in courses relevant to their professional interests, the Humphrey Program
is not appropriate for those who wish to concentrate on academic work
required for a U.S.
degree. Humphrey Fellows spend a considerable portion of their time
engaged in off-campus activities such as internships, field trips, workshops,
and special projects that give them practical experience in their
professional fields. Fellows who
successfully complete the program are awarded a Certificate of Participation.
FINANCIAL PROVISIONS: The Humphrey Fellowship provides a monthly
maintenance allowance, a book and supplies allowance, tuition and fees when
applicable, round-trip international travel to the host institution (and to
the Fellow’s English-language training program when applicable) and domestic
travel to Washington, D.C. for a special seminar. Supplementary funds are
provided for professional activities such as field trips or attendance at
conferences. Humphrey Fellowships are not renewable.
Humphrey Fellows should plan to bring with
them some personal funds to cover incidental expenses not covered in the
grant. Humphrey Fellowships do not include funds for dependents (family
members). Humphrey Fellows are responsible for providing travel, insurance,
and financial support for any dependents accompanying them in the United States.
Please note that English and orientation centers cannot accommodate
dependents. Therefore, dependents should not arrive in the United States
until the Fellows are settled in their academic year programs and have
secured housing (at least 30 days after the Fellow’s arrival) at the host
campus.
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PROGRAM FIELDS: The programs arranged for Humphrey Fellows are related to one of
the following fields: agricultural development/agricultural economics;
communications/journalism; economic development/finance and banking;
educational administration, planning and policy; HIV/AIDS policy and
prevention; human resource management; law and human rights; natural resources and environmental management;
public health policy and management; public policy analysis and public
administration; substance abuse education, treatment and prevention; teaching
of English as a foreign language; technology policy and management; trafficking
in persons, policy and prevention; urban and regional planning. The
university programs do not address themselves to the scientific or technical
aspects of these fields, but rather to broad policy-making and
problem-solving issues.
PLACEMENT IN UNIVERSITY PROGRAMS: Candidates who are selected for fellowships
are placed in clusters by field of interest at U.S. universities specially
designated to host a group of Humphrey Fellows. IIE, therefore, is not able
to make placements at specific universities requested by candidates, or to
award fellowships enabling candidates to attend a U.S. university on the basis that
they have already been admitted. Candidates should not apply directly to U.S.
institutions.
APPLICATION INSTRUCTIONS:
1. Each page of the enclosed application
carries its own instructions and should be read carefully before proceeding. All
forms must be completed in English and typewritten or computer-generated. Please
answer every question as completely as possible (except for the Substance
Abuse form, page 5A of the application, which should only be completed by
candidates in the field of substance abuse).
2. Please take special notice of #13,
"Give a 50-word summary of your proposed program plan." This section is very important as members
of the J. William Fulbright Scholarship Board read this summary and determine
whether to approve Humphrey nominations.
Please be sure to provide a succinct but substantive summary
statement.
3. The completed application must be returned
to the office or nomination committee in your home country according to
the instructions provided by them. (Do not submit the application to IIE.)
4. You must attach complete and certified
academic documents covering your entire period of study at universities or
other postsecondary institutions, including advanced degrees. Documents must
be accompanied by complete English translations.
Your
academic documents must consist of:
• A
certified official record (transcript) from each university or other
postsecondary institution, listing the subjects you studied and the grades
(marks) you received during each year of your enrollment. Include all
postsecondary institutions you attended, even those from which you did not
receive a degree or diploma.
• Certified,
official evidence of each postsecondary or university degree, diploma, or
certificate awarded to you.
To be considered official, each academic
document must bear the seal of the issuing institution as well as the
signature of its officials. Copies of original documents will be accepted
only if they are separately certified as being authentic duplicates of
originals. Certification of copies may be made by the issuing institution, by
your selection committee, or by a U.S. consular official.
5. You are required
to submit two letters of reference, one of which must be from your
immediate supervisor in your current position. The letters of reference
should be written in English or should include an English translation.
6. Important
information about TOEFL: The Test of English as a Foreign Language
(TOEFL) is required by all U.S.
universities. Absence of TOEFL scores could jeopardize your chance of
obtaining a Fellowship. After
passing a preliminary English test, you must register for TOEFL immediately
and take it as early as possible and no later than November 2008. For
information and/or test registration forms, contact the Binational
Education/Fulbright Commission or U.S. Embassy in your home country. You must
indicate that you want your score reports sent to Institute of International
Education (Hubert H. Humphrey Fellowship
Program) Code Number 9616. You must be sure to indicate this code
(9616) on the registration forms or on the answer sheets provided at the
time you take the examination. TOEFL
vouchers will be given to finalists by the Binational Commission or U.S.
Embassy.
As soon as you receive your TOEFL score,
please present it to the Binational Commission or U.S. Embassy.
7. As part of your application, you also must
have a formal English language interview and submit the enclosed English
Language Report Form (page 7 of the application).
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Bio-Sheet A
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1.
NAME OF APPLICANT (Exactly as on your passport/ travel documents) :
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4. SEX:
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(Title) |
(First name) |
(Middle name)
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(Last name)
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2. PERMANENT ADDRESS OF APPLICANT:
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6. DATE OF BIRTH
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Month
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Day
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Year
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3. POSTAL
ADDRESS OF APPLICANT (If same as above, write ‘same’)
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8. COUNTRY OF PRESENT RESIDENCE:
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9. INDICATE YEAR & COUNTRY OF ANY PREVIOUS
FULBRIGHT GRANTS:
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10.
EDUCATION:
List all post-secondary
educational institutions attended, beginning with the most recent, including
any in which you are currently enrolled.
Copies of diplomas, academic transcripts, certificates, and English
translations should be attached. (To
add more information, please add rows or copy table onto an additional
sheet.)
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Name of
institution, university or professional school, and location
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Major
field(s) of study
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Dates
attended (month and year)
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Actual name
of diploma or degree (do not
translate)
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Date
received or expected
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From
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To
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11.
Name
your most significant publications/honors/awards/projects/other
accomplishments:
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12:
GIVE
A 50-WORD SUMMARY OF YOUR PROPOSED PROGRAM PLAN (more complete
plan to be outlined on page 3; be sure this summary captures the essence of
your program plan).
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13.
CURRENT OCCUPATION:
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Your
job title:
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Dates
of employment (month & year):
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Name
and address of your place of employment:
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14. Describe your
current job responsibilities:
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Bio-Sheet B
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15. Previous positions held (begin with most
recent):
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Name &
address of place of employment
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Job
Title
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Dates of Employment
From (in years) To
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17. 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. Please attach an additional sheet
if necessary.
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Reason
for visit
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Country visited
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Dates of visit
From
(mo/yr) To ((mo/yr)
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1.
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2.
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3.
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4.
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5.
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6.
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18. Persons to be notified in case of emergency:
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In home country:
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In the United States:
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Name:
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Name:
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Address:
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Address:
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Telephone:
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Telephone:
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Relationship
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Relationship:
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I certify that all information given in this application is complete
and accurate to the best of my knowledge. I acknowledge that I have completely read
and understood the Information and
Application Instructions and I agree to comply with all regulations
described there. I agree to abide by
the Policies governing the selection of Fulbright/Humphrey grantees, as
established by the J. William Fulbright Foreign Scholarship Board (FSB)
(complete policies available at
http://exchanges.state.gov/education/fulbright/ffsb/policies/2004/) which
supercede all other documents relating to my application for a Humphrey
Fellowship. I also agree to return to
my home country upon the expiration of my program in the United States of America.
(You must sign here in
INK)
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Program Plan |
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19.
(1)Please
describe your major area of interest and explain how this area addresses the
specific development needs of your country.
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(2) Describe the type of Humphrey
program you would like to undertake in order to meet these challenges.
Indicate the kinds of academic course work, internship experiences, and/or
professional training experiences you would like to undertake.
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(3) Describe how the acquisition of
new knowledge and skills will assist you in helping your country to achieve
its development goals.
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Personal Statements A |
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Write a paragraph answering each of
the following three questions. Please use only the space provided
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20. Please describe how you have
demonstrated a strong commitment to public service in your
professional/personal life.
(i.e. professional responsibilities,
community or civic involvement, etc.)
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21. Please state your professional goals
for the next five years and indicate how the training received under the
Humphrey Program will contribute to your managerial skills, leadership
ability, and commitment to public service.
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Personal
Statements B
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22. Describe a problem or challenging
situation that you have resolved by using your initiative. What was the outcome? Please select this example carefully. It should illustrate something that you
want the review panel to know about your problem-solving, leadership
abilities, or commitment to public service.
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Substance Abuse Field of Study
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NOTE: THIS PAGE SHOULD BE FILLED OUT ONLY BY
THOSE APPLICANTS WHOSE PROPOSED FIELD OF STUDY IS SUBSTANCE ABUSE
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Please contact the U.S. Embassy or the Binational Educational
Commission in your country before completing the following: (Your comments
should be continued on a separate sheet if more space is needed.)
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1. Briefly describe what you know about
current substance abuse problems in your country.
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2. Briefly describe recent substance abuse
research project(s) in which you have been engaged, the extent of your role
in these
project(s), and list any publications in
connection with research work that you have done.
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3.
Briefly describe an area of substance abuse research that you would like to
pursue based on the needs in your country.
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Personal Information |
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I. PERSONAL
FINANCIAL INFORMATION (Indicate all
funds in your local currency.)
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1.
Your annual salary
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Income per year from other sources:
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2.
Will your salary be continued during your stay in the U.S.?
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If yes what percentage?
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II. DEPENDENTS:
The Hubert H. Humphrey Fellowship Program does not provide allowances for
dependents. If your dependents accompany you, you will be responsible for
providing all travel, adequate medical insurance, and support for them. English/Orientation Centers cannot
accommodate dependents. Dependents
may not arrive until you are settled in your academic program and have found
housing (at least 30 days after your arrival at academic placement).
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1.
Marital status
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2. List the
relationships and ages of any persons who will require financial assistance
from you during your academic year in the U.S.:
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3. Will any dependents accompany you to the U.S.?
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If yes, give name(s) as shown on
passport(s), gender, relationship(s), date(s) of birth, city/country of birth
and citizenship for each dependent.
Please also state how you intend to provide for them during your year
of study in the U.S.
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III. ACADEMIC
PROGRAM
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1. If required, will you be able to arrive
for English language training as early as April, May, June or July?
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2. Will you be able to obtain a leave of
absence from your current position for a period of 11 months, or up to 14
months if you require English training?
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Yes
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No
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3. When will you take a standardized
test that assessed your English language ability, such as TOEFL?
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If you have not scheduled this test
before November 1, 2008, you must notify the Binational Educational
Commission or U.S. Embassy in your home country immediately.
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IMPORTANT1. An official TOEFL score (no more than two years old) is required for all countries except the English speaking Caribbean.2. You must indicate that you want your TOEFL score reports sent to: Institute of International Education (Hubert Humphrey Fellowship Program) Code Number 9616. You must be sure to indicate this code (9616) on the registration forms or on the answer sheets provided at the time you take the examination.
3. As soon as you receive your TOEFL score,
report it to the Binational Educational Commission or U.S. Embassy.
4. Please sign below as authorization for IIE
to receive your TOEFL score.
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I
hereby authorize the Institute
of International Education
to receive my TOEFL score report.
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Date: __________________________________
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Signature: __________________________________
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Confidential letter of reference from current employer |
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This letter of reference must be
written by the applicant's current supervisor in his/her professional
position.
If
this letter is not written in English, an accurate translation must be
attached
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Name of
Applicant:
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Country:
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Name and Title
of Evaluator:
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Organization or
Employer:
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How long have you
known the applicant?
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Signature (in ink):
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PROGRAM DESCRIPTION
The
Humphrey Fellowship Program provides mid-career professionals from designated
countries of Africa, Asia, Latin America, the Caribbean, the Middle East, and
Eurasia with an opportunity to enhance their professional capabilities
through participation in specialized 10-month programs developed specifically
for small clusters of Humphrey Fellows at selected U.S. universities. Primary
funding for the Humphrey Program is provided by the U.S. government through the
United States Department of State. The Institute of International Education
(IIE) administers the program on behalf of the State Department.
The
types of university programs arranged for Humphrey Fellows depart from a
traditional discipline-oriented focus and have a problem-solving and
experience-sharing emphasis. The programs are not degree-related and not
aimed at providing scholarly preparation or basic training in a field. The objective
is to provide Humphrey Fellows with an overall experience that broadens their
perspectives, enhances their capability to assume greater career
responsibilities, and provides opportunities to establish useful professional
contacts. To accomplish these objectives, programs are designed to include
various combinations of course work, independent projects, internships,
consultations with U.S.
faculty or experts, field trips, and seminars. Under the guidance of a
designated faculty advisor or "coordinator," Fellows plan programs
that best suit their individual career development needs.
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I.
In the rating chart below, please evaluate the applicant in comparison with
other professionals whom you have known during your career.
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Excellent
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Very Good
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Average
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Below Average
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Intellectual Ability
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Knowledge of Field
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Work Habits
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Seriousness of Purpose
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Commitment to National Development
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Resourcefulness and Initiative
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Emotional Maturity
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Adaptability to New Situations
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Leadership Qualities
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Confidential
letter of reference from current employer (cont.)
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<!--
Generation of PM publication page 13 -->II. Please assess the candidate's
suitability for the Hubert H. Humphrey Fellowship Program based on his/her
educational background, work experience and individual needs for career
development. (A description of the Humphrey Program is on the front of this
page.) Include a candid evaluation of the applicant's ability to pursue
serious academic work in the context of a mid-career professional program.
Indicate also how this program will directly benefit not only the candidate's
career but his/her country and society. Also discuss the candidate's
leadership potential and commitment to public service.
(Your
comments should be continued on a separate sheet if more space is needed.)
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Please return directly to the
Selection Committee in the applicant's country or to the Cultural Affairs
Officer of the U.S.
diplomatic mission in the applicant's country. Under no circumstances should
this letter of reference be returned to the applicant.
NOTE: IIE cannot guarantee this
letter's confidentiality once it becomes part of a university's records.
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Applicant Checklist
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PLEASE
SAVE THIS FORM AND REFER TO IT
IN SUBMITTING YOUR APPLICATION! |
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APPLICANT CHECKLIST
FOR SUBMISSION OF APPLICATION
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Completed
Application (Forms 1-2-3-4-5-6)
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Official
transcripts and diplomas with translations if necessary
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1st
Letter of Reference (Forms 8 and 8A)
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Substance Abuse Field of Study form
if applicable (Form 5A)
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Date of TOEFL exam
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