Foreign Language Arabic Teaching Assistant 2009Rev

8/8/2019 Foreign Language Arabic Teaching Assistant 2009Rev

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FULBRIGHT PROGRAM

Application for foreign language teaching assistantship in the United States

General Information

1.NAME (as it appears or will appear on your passport)Family First Middle

Mr.

Ms.

______________________________________________________________________________________2.NAME ON PREVIOUS RECORDS (if different in content or spelling from above)

Family First Middle

3. PERMANENT MAILING ADDRESS:

Street___________________________________________________

City_____________________________________________________State/Province____________________ Postal Code______________

Country__________________________________________________

Telephone: ______________________ E-mail: __________________Cellphone: ______________________

4. DATE OF BIRTH: (Month/Day/Year)________________________5. CURRENT AGE: ____________

6. GENDER________________________7. BIRTHPLACE: (City, State/Province, Country)______________________

8. COUNTRY OF CITIZENSHIP__________________9. COUNTRY OF RESIDENCE _________________________

10. DO YOU NOW OR HAVE YOU EVER HELD:

U.S. CITIZENSHIP? ____________

U.S. DUAL CITIZENSHIP? ___________

U.S. PERMANENT RESIDENCY? _______

PLEASE SELECT ONLY ONE OF THE FOLLOWING REGARDING YOUR POSSIBLE ROLE ON A U.S.

UNIVERSITY CAMPUS

11. IN MY ROLE AS A LANGUAGE ASSISTANT ON A U.S. UNIVERSITY CAMPUS, I AM WILLING TO:

_ Perform actual classroom teaching duties_ Be primarily an assistant

_ Both teach and assist


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12. WOULD YOU BE WILLING TO ACCEPT PLACEMENT IN ANY GEOGRAPHIC AREA? (limiting the regions

may reduce the likelihood of final selection) Yes No

13. IF YOU WOULD BE UNWILLING TO ACCEPT PLACEMENT IN ANY GEOGRAPHIC AREA, PLEASE

INDICATE WHICH REGION YOU WOULD NOT ACCEPT. (Please skip to question #14 if you selected Yes to #12

above)

NortheastMid-AtlanticSoutheastMidwestSouthwestRocky MountainWest Coast

14. WOULD YOU BE UNWILLING TO ADAPT TO ANY OF THE FOLLOWING INSTITUTIONAL PROFILES?Please select all that apply (an inability to adapt to a new or different environment may reduce the likelihood of final

selection). Single gender student body Urban location Rural location Small population Large population Little ethnic diversity Great ethnic diversity Offers coursework on an audit basis Requires specific coursework on a credit basisN/A, I would accept all


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15. OBJECTIVES: Write a clear and detailed description of your objectives.Emphasize your qualifications, areas of expertise and career goals. Give your reasons for applying to the

Program and the role you expect to have on campus.


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16. NON-ACADEMIC INTERESTS: Please list any non-academic interests (e.g. sports, music, art, etc) Includeinformation about your experience in these areas.

Note: Please limit your response to the size of this text box. Anything over this size will not display or print on your submitted application

17. ARE YOU PURSUING ANY OTHER SCHOLARSHIP, FELLOWSHIP OR EMPLOYMENT THAT WOULDSUPERCEDE YOUR PARTICIPATION IN THE FLTA PROGRAM SHOULD IT BE OFFERED? PLEASE EXPLAIN:

Note: Please limit your response to the size of this text box. Anything over this size will not display or print on your submitted application

18. DEGREE: PLEASE INDICATE THE LAST DEGREE YOU COMPLETED. PLEASE DO NOT LIST

CERTIFICATES IN THIS SECTION.

Degree (ex. Masters, Bachelors) or Equivalent (ex.Magister, Maestria, Bakkalaureus, Matrise)

In What Field (please list the field of study as it appearson the degree)

19. EDUCATION: LIST EDUCATIONAL INSTITUTIONS ATTENDED IN REVERSE CHRONOLOGICAL ORDER,

INCLUDING ANY IN WHICH YOU MAY BE PRESENTLY ENROLLED.

Name of

Institution/Location

Major Field of Study Dates (Month and year)From To

Actual Nameof Degree or

Diploma (Do nottranslate)

Date Receivedor Expected

University or Professional

Secondary


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20. LIST SCHOLARSHIPS OR FELLOWSHIPS HELD AT PRESENT OR IN THE PAST. GIVE SOURCE ORSPONSOR, AMOUNT, WHERE HELD, DURATION AND YEAR. Note: Please limit your response to the size of this text box.

Anything over this size will not display or print on your submitted application.

21. INDICATE ACADEMIC HONORS OR PRIZES WHICH YOU HAVE RECEIVED. Note: Please limit your response tothe size of this text box. Anything over this size will not display or print on your submitted application.

22. OCCUPATIONAL EXPERIENCE: CLEARLY INDICATE YOUR EMPLOYMENT HISTORY, BEGINNING

WITH YOUR MOST RECENT POSITION. YOU MUST COMPLETE ALL RELEVANT FIELDS.

Name and address of employer Type of Work

(Position Held)

DatesReason for leaving

Note: If position still held, please

note as ongoingFrom To

23. TEACHING EXPERIENCE: IF YOU CURRENTLY OR PREVIOUSLY HELD A LANGUAGE TEACHINGPOSITION, PLEASE ESTIMATE THE NUMBER OF MONTHS OR YEARS YOU OCCUPIED THE POST?______

MonthsYears

24. LIST PROFESSIONAL SOCIETIES, FRATERNITIES OR OTHER ORGANIZATIONS IN WHICH YOU

NOW HOLD MEMBERSHIP OR IN WHICH YOU HAVE BEEN ACTIVE IN THE PAST (Indicate if you have heldelective office)Note: Please limit your response to the size of this text box. Anything over this size will not display or print on your

submitted application.


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25. IF YOU HAVE TRAVELED OR LIVED IN ANY COUNTRY OTHER THAN YOUR OWN INDICATE

PLACES, DATES AND REASONS.Note: Please limit your response to the size of this text box. Anything over this size will notdisplay or print on your submitted application.

26. LANGUAGE SKILLS: Please respond to all of the following fields even if Mother Tongue and Language of

Nomination are the same. Please indicate N/A if any of the following fields are not applicable.Category Name of Language Proficient (Excellent, Good, Fair Poor)

Category Name of Language Proficient (Excellent, Good, Fair Poor)

Language of Nomination

Mother Tongue

Second Language

Third Language

27. Examination Results: Recommended: Research next available exam dates if you dont already have scores:

TOEFL Date Taken/To be Taken

Month/Year ___________ Test _____________ Score __________

IELTS Date Taken/To be Taken

Month/Year ___________ Test _____________ Score __________

Candidacy will not be finalized until English language proficiency scores are received. Please inquire with your home

country contact regarding TOEFL vouchers. There are no IELTS vouchers available. Your home country contact for the

FLTA Program can be located at http://www.flta.fulbrightonline.org/thinking_apply_now.html .

28. Provide the name, address and telephone number of individuals to be notified in case of emergency

In Home Country In the United States List Below any close relatives or

friends in the United States (name,

address, and relationship)


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29. COURSE INTEREST: The FLTA Program is a non-degree program. You will be expected to take one course

in American Studies and three additional courses at your host institution on a credit or audit basis for enrichment

purposes. Name three courses you may be interested in taking and why?

Course Reason1.

2.

3.

30. TEACHING THE LANGUAGE OF NOMINATION: You may be asked to teach your own class. If so, what

teaching methodologies and techniques would you apply to the teaching of the language for which you have

been nominated? Mention any innovative approaches you have utilized as a teacher or encountered as a learner

that you may employ.


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31. SHARING YOUR CULTURE: Imagine you have to represent your country at an International Festival your

host school is organizing. What aspects of your language and culture would you choose to present?


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32. Personal Statement:Please write a narrative concerning your personal history and long-term goals; it should not be a mere listing of

facts, nor should it be a copy of the essay provided in #14 of this application. Please see the "Tips" in the

Instructionsbefore submitting your essay.


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CONFIDENTIAL LETTER OF REFERENCE

This letter of reference must be written by a teacher under whom the applicant has studied or by someone who has

supervised the applicant in work, athletics or other relevant activity. This letter must be in English. If not in English,

then an accurate translation must be attached.

Name of Applicant

Country ISRAEL

Name of Referee

1. How long have you known the applicant?

2. In what capacity have you known the applicant?

Teacher or Professor Employer or Job Supervisor

School Counselor Other (please specify)

3. Please provide a candid evaluation of the applicants past performance and ability to pursue and successfully

complete a teaching assistantship in the United States. Your statement will be given considerable importance by

the American universities/colleges reviewing this application, and should, therefore, be as complete and detailed aspossible.


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CONFIDENTIAL LETTER OF REFERENCE FOR (continued)

4. In the rating chart below please evaluate the applicant in comparison with other students whom you have known

during your professional career.

Excellent Very Good Average Below Average

Creative

Motivation

Self-confidence

Independence, initiative

Intellectual ability

Academic achievementDisciplined work habits

Adaptability to New Situations

Leadership Qualities

Potential for growth

5. Please indicate where the applicant would rank among students/employees currently or recently in your

department/organization.

95% 90% 75% 50% 25%

TOP BOTTOM

__________________________________________________________________________________________________

Name and Title (print)

School, Company or Organization

Signature Date


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This reference must be received by the United State-Israel Educational Foundation by the end of working hours on

January 5, 2009.Please mail the reference directly to USIEF,

P.O. Box 26160, Tel Aviv 61261, or transmit it by fax to 03-516-2016.


This letter of reference must be written by a teacher under whom the applicant has studied or by someone who hassupervised the applicant in work, athletics or other relevant activity. This letter must be in English. If not in English,


Name of Applicant

Country ISRAEL

Name of Referee





3. Please provide a candid evaluation of the applicants past performance and ability to pursue and successfullycomplete a teaching assistantship in the United States. Your statement will be given considerable importance by

the American universities/colleges reviewing this application, and should, therefore, be as complete and detailed as

possible.


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Creative

MotivationSelf-confidence



Academic achievement

Disciplined work habits




5. Please indicate where the applicant would rank among students/employees currently or recently in your

department/organization.

95% 90% 75% 50% 25%

TOP BOTTOM

__________________________________________________________________________________________________



Signature Date


14/16





This letter of reference must be written by a teacher under whom the applicant has studied or by someone who has

supervised the applicant in work, athletics or other relevant activity. This letter must be in English. If not in English,


Name of Applicant

Country ISRAEL

Name of Referee





3. Please provide a candid evaluation of the applicants past performance and ability to pursue and successfully

complete a teaching assistantship in the United States. Your statement will be given considerable importance by

the American universities/colleges reviewing this application, and should, therefore, be as complete and detailed as

possible.


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Creative

Motivation

Self-confidence



Academic achievement

Disciplined work habits




5. Please indicate where the applicant would rank among students/employees currently or recently in yourdepartment/organization.

95% 90% 75% 50% 25%

TOP BOTTOM

__________________________________________________________________________________________________




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Signature Date




Foreign Language Arabic Teaching Assistant 2009Rev

Documents

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